Order PositiveSSL Certificate Use this form to submit a special payment to AMS Computer Services. * Domain name must be set up on an AMS web server! Certificate InformationThis information will be tied to your certificateThis is a new certificateThis is a certificate renewal Domain Name for Certificate: Certificate Validation Period:1 Year Company Name: Company Division: City of Company: State of Company (Full Name): Country of Company (2 Letter Abbr.): Certificate Email Address: Payment Information Stated Price:$18.95 - USD Your Name: Email Confirmation: 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:This option is only valid if you have a credit card on file.If you pay your web hosting account viaPayPal we won't have a credit card on file for your account.Account Username:Account Password:ORLast four digits of card: Use the payment information below Payment Type: Credit Card Number: CVC: Credit Card Expiration: January - 01 February - 02 March - 03 April - 04 May - 05 June - 06 July - 07 August - 08 September - 09 October - 10 November - 11 December - 12 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Name on Card: Street Address of Cardholder: Zip Code of Cardholder: Comments or Special Instructions THIS CHARGE IS NON-REFUNDABLE! Please be sure that the Domain Name for this certificate is correct!