REFERRAL FORM

Become an affillate
To learn more about our Referral affiliate program, please call 416-732-1686
Referrer's Information *
Referrer's Information
CLIENT INFORMATION
Client's Name *
Client's Name
http://
Client's Phone Number *
Client's Phone Number
Subject to third party pricing. Pricing as of December 4th, 2016.
Services Required *
Domain Registrar, Login info and password. i.e. godaddy.com | fred@mydomain.com | abc123
Optional Credit Card Information, otherwise please call 416-732-1686
Name on Credit Card
Name on Credit Card
Card Expiration Date
Card Expiration Date
Credit Card Billing Address
Credit Card Billing Address
Terms and Conditions *
*416Media.com will set up the hosting subscription package provided by a third party on behalf of the client. The client agrees to the terms and conditions of the hosting company. All prices can change without prior notice. All credit card information provided will be kept private and destroyed after completing the set up. For more information, please contact 416media.com