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Web Hosting Since 1996
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As low as $16.95/year - Includes Installation



Use this form to submit a special payment to AMS Computer Services.
* Domain name must be set up on an AMS web server!

Certificate Information
This information will be tied to your certificate
This is a new certificate
This is a certificate renewal
Domain Name: ?
Please pay special attention to the Domain Name that you enter here
Certificate Validation Period
Company Name:
Company Division:
City of Company:
State of Company (Full Name):
Country of Company
(2 Letter Abbr.):
E-mail Address:
Payment Information
Stated Price:$18.95 - USD
Your Name:
E-mail Confirmation:
(This is the address we will write back to)
Payment Method:Use Credit Card on file used to pay for web hosting fee
We need to verify account ownership before we can authorize this charge on this card. Please provide account ownership verification through one of the methods below:
Account Username:
Account Password:
OR
Last four digits of card:
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Payment Type: We Accept Mastercard We Accept Visa We accept American Express We Accept Discover Card We Accept PayPal
Card Number: CVC:
Card Expiration:
Name on Card:
Street Address of Cardholder:
Zip Code of Cardholder:
Comments:

THIS CHARGE IS NON-REFUNDABLE!
Please be sure that the Domain Name for this certificate is correct!


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