Alpha Commerce - Account Information Form

Manual credit card processing using your current merchant account.
Before providing payment information please complete the form below and a total price will be calculated for your confirmation.
Special Offers:
10% account credit to Alpha Internet hosting customers.
10% discount for new Alpha Commerce accounts moving their web hosting to Alpha Internet.

My web site is currently hosted by Alpha Internet, Inc.
I would like to see check into hosting myweb site with Alpha Internet

Your account will be activated immediately.

Price Summary:
Setup Charge: $70
Monthly Charge: $15

Feature Summary:
Real Time Card Processing
Shopping Cart, Secured Server

Account Information

E-Commerce for:

Orgnization Name:

Contact Person First Name:

Mr. Ms.

Last Name

Address:

City
State, Zip:

Country:

Phone

Fax

Texas orders subject to 6.25% sales tax.