Please turn Word Wrap feature off to print!!! COMMERCIAL ACCOUNT APPLICATION Mail to:Ripco Communications,Inc. 3320 W. Foster Ave. STE 242, Chicago, IL 60625 Ripco Communications Inc. is a registered corporation in the state of Illinois, providing commercial and personal Internet access services. Completing and signing this form indicates that you are eighteen (18) years of age or older and have read, accepted and agreed to Ripco's Acceptable Use Policy (available on our website. If you would like a hard copy of this document mailed to you, please contact our offices at 773-528-5020. Usage of Ripco accounts in violation of this policy may result in immediate termination of the account. Termination of accounts for this reason is not subject to refund. We reserve the right to cancel or refuse service to anyone for any reason. Accounts are fully refundable for two weeks after activation. Refunds after two week period are handled on a case-by-case basis. 1. All commercial web hosting packages include 1 hosted domain, pop mail account with access to Web Mail, CGI script and PHP script directories. Select the Commercial Web Hosting package you wish to apply for: X __Hosting & Dial-up Package - $30 month$90/quarter$330/annually - Up to 200 Mb storage - 2 Additional domain Records - 1 Dynamic IP dial-up account - Up to 10 Pop Mail accounts __Economy Package - $10/month $110/annually - Up to 50 Mb storage __Regular Hosting Package - $15/month $165/annually - Up to 200 Mb storage - Up to 5 Pop Mail Accounts - 2 Additional Domain Records Deluxe Hosting Package - $20/month $220/annually - Up to 200 Mb storage - Up to 10 Pop Mail Accounts - 4 additional domain records 2. Additional Services ___PHP - No additional cost. Requires special set-up. ___Secure Server - add $20 per month, ___Database Server - add $20 per month without Secure Server. Included w/Secure Server 3. Account Information (this information is kept confidential and is used to verify identity only.) Account Name ---------------------------------------------------------------------- Billing Contact Name ---------------------------------------------------------------------- Billing Contact E-mail ---------------------------------------------------------------------- Billing Contact Phone ---------------------------------------------------------------------- Technical Contact Name ---------------------------------------------------------------------- Technical Contact E-mail ---------------------------------------------------------------------- Technical Contact Phone ---------------------------------------------------------------------- Address Line 1 ---------------------------------------------------------------------- Address Line 2 ---------------------------------------------------------------------- City, ST, Zip ---------------------------------------------------------------------- Fax Number ---------------------------------------------------------------------- After Hours Technical Contact Phone ---------------------------------------------------------------------- 4. Preferred Login Name Choices: (8 letters or numbers used to log into the Ripco network and which will become the primary e-mail address for your account.) a. ---------------------------------------------------------------------- b. ---------------------------------------------------------------------- c. ---------------------------------------------------------------------- Signature of Authorized Agent ---------------------------------------------------------------------- Date ---------------------------------------------------------------------- Payment Method (Circle One) Check/Money Order Enclosed Visa/MasterCard Pay Pal