Bullet Proof Dedicated Server Order Form

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Bullet Proof Dedicated Server Order Form
*Name:
Company:
*Address:
*City:
*State/Province:
*ZIP:
*Country:
*Phone:
FAX:
*E-Mail:
*Secondary E-Mail:
Website URL:
*Server Type:
Operating System:	Linux Windows 2003 FreeBSD
Optional:	For Server GOLD only: Upgrade to 2GB RAM - $100 (One Time charge)
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Payment Information
First month payment must be paid by Wire Transfer or a Verified Paypal Account or Western Union or e-gold only. Subsequent monthly payment can be paid by credit card. Payment information will be provided after your order is received. Payment Method: By Verified Paypal Account - Your Paypal Account: By e-gold By Western Union By Wire Transfer
Remarks:
I have read, acknowledged, and to the Terms of Service.