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 Information
This information will be tied to your certificate
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:
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 via
PayPal we won't have a credit card on file for your account.

Account Username:
Account Password:
OR
Last four digits of card:
Payment Type:
 
Credit Card Number: CVC:
Credit Card Expiration:
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!