Account Registration

www.studiokovacs.com

Client Account Information Required fields are marked with an asterisk.(*)

* DOMAIN REGISTRATION (yourwebsite.com, .org, .net, .info, .biz, .us, .tv, etc.)

Leave this empty if you already have a domain, or have recently registered it.

Preferred (1-5 names): Secondary (1-5): Suggestions (1-5):

* First Name:

* Last Name:

* Email Address:

* Primary Phone Number: Secondary Phone Number:

* Company Name: * Shipping Address Line 1:

Shipping Address Line 2:

* City: * State/Province: * Zip/Postal Code: * Country:

Visit our website for complete details on our Privacy Policy.

Kovacs Creative Agency, 2009.

Account Registration

www.studiokovacs.com

Client Billing Information Please note that we will add this credit card to your account and it will automatically be used whenever you decide to make a feature purchase, including automatic renewals or monthly hosting & maintenance. ……………………………………………………………………………………………………………………………………………..

Billing Address Fields marked with an (*) are required. Please enter the billing address associated with your credit card (the one you will be using to pay the monthly hosting price). * Street Address 1

Street Address 2

* City: * State/Province/Region: * Zip/Postal Code: * Country: * Phone Number:

Billing Information (Used primarily for Automatic Billing for Maintenance & Hosting) * Name on Card:

* Card Type:

* Credit Card Number:

* Expiration Date:

Visit our website for complete details on our Privacy Policy.

Kovacs Creative Agency, 2009.

Account Registration