Starr Internet Order Form

To move from field to field, or to make a selection, use your mouse. Some browsers also support the TAB key for moving from field to field. If you inadvertently hit ENTER and Send the form before it is complete, use your browser's BACK key to return to the form, and then finish filling it out and then Send it again.

When you are ready to submit the form use your mouse to press the Send Request button at the bottom of the page--and THANK YOU for your interest in Starr Computer Systems's products.

NOTE: Fields marked with an asterisk* are required for proper processing.

General Account Information

Your Name*:
Company Name*:
Address Line One*:
Address Line Two:
City*:	State*:
ZIP/ Postal Code*:
Country (If not the USA):

Phone*:
Fax:
E-Mail Address*:

Billing Address (If different)

Name*:
Company Name*:
Address Line One*:
Address Line Two:
City*:	State*:
ZIP/ Postal Code*:
Country (If not the USA):

Your Account name is used for your FTP log-in user I.D., as well as the actual top directory name of your server account. It must be 2 to 8 lowercase letters in length. No guarantee is made concerning the availability of a particular account name. An account password of 7 or 8 characters is also required, but should be specified via telephone, fax, or when you mail your check for the account.

Preferred Account Name: (2 to 8 lowercase letters)

Your domain name is a name such as "abc.com" (business) or "adb.org" (nonprofit) that is used for your WWW, FTP and virtual Email addresses. No guarantee is made concerning the availablility of a particular domain name. Please specify a first and second choice.

Preferred Domain Name:

Alternate Domain Name:

A brief description of your organization is required for domain name registration:

How would you like to be contacted?

Call

USmail

Fax

Any additional information, suggestions, or comments?

Thank you!