Date: ______________________


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: ______________________________  

   

 

#=========================================================================================

Please mail your sign up form, your business card or a newspaper ad, picture (if any), along with your payment to : Viet Internet * 1659 N. Capitol Ave #143  San Jose, Ca. 95132 * Phone:(408) 975-0497 * Fax: (707) 248-2082

Please notice your order can not be processed until your payment is received, this amount is non-refundable. We will mail you a receipt along with the address of your email and business homepage upon completion.

Thank you for your business.