Email Account Order Form PhoneStep 1. CHOOSE YOUR EMAIL ACCOUNT Email Account Type * — Select Email Account — Premium Email – $3/month Premium Email Plus – $5/month Hosted Exchange – $12/month Office 365 Business Premium – $18/month Requested Email Address(es) *Step 2. DOMAIN NAME INFORMATION Domain Registration * New Domain I already have a domain name and will keep it with my current registrar I already have a domain and wish to transfer it to Clearlight Domain Name * Alternate Domain Name Step 3. CONTACT INFORMATION Company Name * First Name * Last Name * Email Address * Address * City * State/Province * – Select Province/State –AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ====================AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip/Postal Code * Country * Phone Number * Step 4. BILLING INFORMATION Billing Service Period * — Select Service Period — Automatic Monthly Credit Card Billing Quarterly Invoice 6-Month Invoice Annual Invoice Payment Method * — Select Payment Method — Credit or Debit Card Check or Money Order Credit Card Type — Select Credit Card Type — Visa Mastercard American Express Discover Credit Card Number Credit Card Expiration Date Credit Card CVC Number Name of Card Holder Credit Card Billing Address Credit Card Zip Billing Contact Info Billing Contact is different than the Primary Contact Billing Contact is the same as the Primary Contact Billing Contact Name Billing Contact Email Address Billing Contact Mailing Address Billing Contact Phone Number Comments / Special NeedsThe data you provide is secured through SSL and PGP.