Pensinger.net Email Services Order Form

Name______________________________________________

Address____________________________________________

City ______________   State _______  Zip Code ____________

Current Email Address: _________________________________

Desired Email Address: _________________________________

Account Type: POP3 _________     Alias ___________________

Forwarding Address for Alias Acct: ________________________

Payment Type

Money Order  ____    Certified Check ____   Personal Check ____

Please mail this form and payment made out to Mike Pensinger to:

Pensinger.net Email Services
2424 Sewells Point Road
Norfolk, VA 23513