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Costa Rica Website Hosting

Please complete the following application with all information that applies to you to order your new hosting plan. If you wish to order more services, you will be given that option after submitting this form.

IMPORTANT: The following application will provide us with enough information to understand your business. Completing this application DOES NOT commit you to the account, and ALL information is kept confidential and stored on our secure servers for a minimal amount of time.


Contact Information
Business Name (if company)
Contact Title
*Contact Name
*Contact Surname
*Contact E-mail
*Contact E-mail Confirmed
*Telephone
Mobile Telephone
Alternative/Business Telephone
Best Time to Call
Facsimile

Hosting Account Details

Plan    
Linux Shared Plan 1 $875 (120 MB)
Linux Shared Plan 2 $1370 (300 MB)
Linux Shared Plan 3 $1870 (500 MB)
Linux Shared Plan 4 $2200 (650 MB)
Windows 2k Shared Plan 1 $1300 (120 MB)
Windows 2k Shared Plan 2 $2170 (300 MB)
Windows 2k Shared Plan 3 $3920 (500 MB)
Linux Dedicated *$1230 ($530/mnth)
Windows 2k Dedicated *$1590 ($690/mnth)
Windows 2k Dedicated w/ SQL DB *$1900 ($800/mnth)
*Gaming clients for Unlimited Bandwidth *Add $900 ($300/mnth)
Dedicated Streaming Audio

$2350 ($600/mnth)
Dedicated Streaming Audio/Video $2700 ($800/mnth)
Dedicated Multi-Broadcast Audio/Video *$2700 ($800/mnth)
*Additional Encoder *Add 250/mnth
Co-Location - 1U *$2150 ($600/mnth)
Co-Location - 2U *$2200 ($650/mnth)
Co-Location - 3U *$2250 ($700/mnth)
Co-Location - 4U *$2300 ($750/mnth)
Co-Location - 5U *$2350 ($800/mnth)
Co-Location - 6U *$2400 ($850/mnth)
Co-Location - Full Cabinet *$4550 ($1550/mnth)
*Gaming clients for Unlimited Bandwidtch *Add $300/mnth
Anonymous Domain Registration needed? yes no

Domain Registration needed?
yes no

If yes, Requested Domain Name

If no, Current Domain Name
No. of Years Registered
Location
Technical Contact
Telephone



Corporations (IBCs)
Belize Corporation
Panama Corporation
Costa Rica Corporation
Dominica Corporation
Seychelles Corporation
Singapore Corporation
E.U. Corps -
U.K. Corporation
Gibraltar Corporation
Malta Corporation
Cyprus Corporation

Trusts
Belize Trust

Merchant Accounts
U.S. Merchant Account
Offshore Merchant Account

Bank Accounts w/Debit
Caribbean Personal
Caribbean Corporate
Belize Personal
Belize Corporate
Panama Personal
Panama Corporate

Debit/Credit Cards
Secured Maestro Debit Secured Visa Credit
Virtual MasterCard Credit

Website Hosting
U.K. Hosting Account
Costa Rica Hosting Account
Belize Hosting Account

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