Account Sign-Up & Agreement
Section 1 - Contact Information
Company Name
Contact Person
Address
City	State Zip
Phone Number
Fax Number
Current E-mail Address
Section 2 - Payment Information
Credit Card Type	-- Select Credit Card -- VISA MasterCard American Express Discover Card
Card Number
Expiration Date
Name on Card
Zip Code where Credit Card billing statements are sent.
Section 3 - Choose Your Service
Internet Access Account	NO Basic - Complete section 4 below. 5-User Professional - Complete sections 4, 4a, and 4b. Full-Time Dedicated - Complete sections 4 and 4a below.
ISDN Access Account	NO 64K Dial-Up - Complete sections 4 and 4a below. 128K Dial-Up - Complete sections 4 and 4a below. 64K Dedicated - Complete sections 4 and 4a below. 128K Dedicated - Complete sections 4 and 4a below.
Domain Hosting Account	NO NT Standard Hosting - Complete section 5. NT Pro Hosting - Complete section 5. Unix Bronze Hosting - Complete section 5. Unix Silver Hosting - Complete section 5. Unix Gold Hosting - Complete section 5. Ecommerce Bronze Store Hosting - Complete section 5. Ecommerce Silver Store Hosting - Complete section 5. Ecommerce Gold Store Hosting - Complete section 5.
Section 4- Dial-Up & ISDN Account Information
Choose Your Primary Logon Name (User ID)	(1st choice) (2nd choice)
Choose a Password	(minimum 6 characters)
E-mail Address #1	@ztc.net
E-mail Address #2	@ztc.net
Operating System: MS Windows 3.1 MS Windows 95/98 MS Windows NT Macintosh UNIX/Linux Other
Modem Speed: 14.4  28.8  33.6  56k  ISDN
How did you hear about our service? Phone Book  Referral Newspaper/Magazine  Radio/TV  Other Web Site
4a - Additional E-Mail Account Information (5-User Prof, Full-Time Dedicated & ISDN accounts ONLY)
E-mail Address #3	@ztc.net
E-mail Address #4	@ztc.net
E-mail Address #5	@ztc.net
4b - Additional User Logon Names (5-User Professional accounts ONLY)
Logon Name #2	Password (6-character minimum)
Logon Name #3	Password (6-character minimum)
Logon Name #4	Password (6-character minimum)
Logon Name #5	Password (6-character minimum)
Section 5 - Domain Account Information
Domain Name
Is this a NEW Domain Name to be registered or is this domain name being transferred from another hosting provider?	New Domain Name Registration Domain Transfer
If this is name is being transferred, please provide the following...
Name of current hosting provider:
Phone number of current hosting provider:
Select a User ID Name and Password (required)
Login Name:	Password: (6 character min.)
Billing Information (Complete only if different from above)
Company Name
Contact Person
Address
City	State Zip
Phone Number
Fax Number
E-mail Address
Section 6 - Order Authorization and Acceptance of Terms
By submitting this form, the person and/or organization represented herein duly authorizes Z-Tech to setup the account's) specified above, and if requested, register a domain name on their behalf or arrange for transfer of the domain name listed above, and if ordering NT Commerce Hosting Package, authorizes Z-Tech to purchase on their behalf an SSL certificate from Equifax, Inc. The above named person states that he/she has read and fully understands and agrees to be bound by the terms of the Account Aggreement, as well as any other terms and conditions as may be set forth by other third party vendors including, but not limited to Network Solutions, Inc., and Equifax, Inc. The above named person fully authorizes Northwest Advantage to charge the credit card listed above for the total amount shown above, as well as any and all recurring charges when due.