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VIET INTERNET
STARTER-PLAN WEB HOSTING AND DESIGNING
SIGN UP
FORM
Please attach your Business
Card or an Ad Sample OR fill out the form below
Name of
Business:
___________________________________________________
Owner:
____________________________________________________________
Address:
___________________________________________________________
Telephone:_____________________________ Cell:
________________________
Email (if any):
_______________________________________________________
Type
of Business:
____________________________________________________
Business Hours:
_____________________________________________________
Details about Your Business:
___________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Comment:___________________________________________________________
__________________________________________________________________
___________________________________________________________________
Total Amount Paid: $ 50/year x ________year =
$____________
Business Owner Signature: ______________________________
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