Order Form

Clem Systems Web Service allows you to choose the flexibility you need at a price you can afford.

All fields with an * must be filled in, or we can not process your order. If you do not have a Domain Name you can order one here.

*First Name:

Billing Name and Address must match the credit card you are using.

You will receive a confirming email with instructions. If you do not receive confirmation with in 24 hours please contact us here.

All payments are due in advance.

If you do not have a Domain Name you can get one here.

* Last Name:

Business Name:

*Email:

* Billing Address:

* City:

* State:

* Zip Code:

Ship to Address:

Ship to City:

Ship to State:

Ship to Zip:

* Day Phone:

Fax:

Night Phone:

* Domain Name:

* Adult Site?
Yes No

Comments:

You must type yes in the box below to indicate you have read and agree to the Acceptable Use Policy.

I have read and agree to the Acceptable Use Policy.