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New Customer Information Form.
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Desired account?
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NO REFUND will be given on the Setup/last-month Fee(s) for ANY Reasons.
, see our policies for more info on refund.
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First name?
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Last name?
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Email address?
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Business name?
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Please describe your organization (or yourself!).
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Operating System/ControlPanel*:
Optional Features:
Gold Watch - $0 setup + $50/month extra
Extra Memory:
Extra IPs:
* Without our default install, we will not install our default controlpanel program. Please contact us for more info.
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Mailing & Contact Information.
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Street address (1)?
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Street address (2)?
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City?
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State/Country? (2 letter code)
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Zip/postal code?
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Country?
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Phone number?
Please make sure this is a number where we can call you to confirm your order.
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Fax number (if applicable)?
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Domain Name Registration.
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Check to see if your desired domain name is already taken by clicking here!
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Domain name ? (machinename.yourdomain.com)
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http://www.
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Desired Password? (Use 8 characters upper and lowercase with numbers)
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Payment Information.
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Sentris accepts payment in the form of a check (or money order or virtual check or wire transfer via Western Union) as well as Visa/MasterCard/Discover Card.
For credit card payment, you will be charged for the first month plus the appropriate setup/last-month fee;
Payment is due on the day you placed your order of each month. Your account will be configured within 6 hours of the submission of this form.
For Check or Money Order, please send payment
for the first three months of service plus a setup fee along with a signed authorization form, that you will get after you finalized your order; You will then be billed every three months for
the upcoming quarter's service. Your account will be activated on receipt
of payment. Returned
checks and charge backs are subject to collection and a $45.00 fee.
For Money Order from Countries outside USA, there might be an additional charge of US$50 if the Bank who's issuing the Money Order charges a $50 fees to us.
Once you submitted this order form, you will receive an e-mail from our Billing Dept. confirming that we've received your order, print and fill-out a signed authorization form, that you will get after you finalized your order, then fax it to
206-577-4763 or mail it to:
Sentris Network LLC
19662 Aurora Ave N
Seattle, WA 98133
US
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Payment Period?
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Payment Method?
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Credit Card Information.
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If you are paying via Mastercard or VISA or Discover or Amex, please provide your credit card or your reseller ID information (if any) below then fax or mail us a signed authorization form, that you will get after you finalized your order. You can also just fax us
your credit card info along with the signed authorization form, that you will get after you finalized your order, to 206-577-4763.
If you pay by paypal, please send payment to billing@sentris.com, after you placed the order.
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Name on Card?
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Card Address
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Card city, state, country?
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Card zip?
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Card Exp. Date (mmyy)
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Card Number (xxxx-xxxx-xxxx-xxxx)
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Your Reseller ID (if any)
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How did you find out about us?
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Paying with Virtual Check ($5 OFF).
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If you want, you can also pay with Virtual Check (You must have a U.S. based checking
account to use Virtual Check) and get $5 OFF your setup fee.
NOTE: We require 3 months payment in advance for Virtual Check. The same as for Check or Money Order or Electronic Check.
To pay with Virtual Check, just fill-out your Checking Account Information below (All fields are required) then fax or mail a
signed authorization form, that you will get after you finalized your order, along with your signed check. The advantage of using this Virtual Check is that instead of waiting
days for the mail - we can process your order in moments, just like a Credit Card order. You
will then receive the check we produced with your other
cancelled checks in your normal bank statement.
 Now using the following lower portion of a personal check as an example,
enter the information that appears at the bottom of your check.
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Your Checking Account Information.
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Enter the series of nine numbers between this symbol
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Enter the series of numbers found before this symbol
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Check Number
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Check Date (dd/mm/yy)
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Name of Bank
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City of Bank
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State of Bank (2 letter code)
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Phone Number of Bank
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Drivers License or State ID Number or Social Security Number
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State: Number: SS#:
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Mailing a Check or Money Order.
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Please make checks (min. 3 months plus setup fee) payable
to "Sentris Network LLC" and mail it along with a signed authorization form, that you will get after you finalized your order, to the following address:
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Sentris Network LLC
19662 Aurora Ave N
Seattle WA 98036
Fax: 206-577-4763
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If
you agree to abide by our policies, enter I agree
here:
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Thank you for your interest!
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Don't Click Here
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