Referred By:

Global Business Resources Corp. Tel/FAX: (03)5974-0597 Keitai: +81 90 6307-0731 dave [*$at*] webhostinginjapan com

WebHostingInJapan.com  Purchase Order Renewal New Client Qty Unit Price Amount  Hosting Plans Junior 1 year 100MB unlimited email 36,000 Deluxe 1 year 500MB unlimited email 180,000 Premium 1 year 1000MB unlimited email 360,000 Years Qty Unit Price Amount  Domain Name Registration Group 1 (.com, .org, .net) Min 1: 3,000 Group 2 (.us, .info, .biz) Min 2: 3,000 Group 3 (.bz, .cc) Min 1: 8,500 Group 4 (.nu) Min 2: 8,500 Register These Domains: Qty Unit Price Amount  Email Accounts Junior 3,000 Deluxe 9,000 Register These Email Addresses: Sub-Total Tax Total

Contact Information Please fill this out clearly and remember should you move, or leave Japan, please send us a note by email or fax. Member Name Mr. Ms. Company Address Tel (H) Tel (W) FAX Email

Payment * Send funds by either bank transfer or postal account. Postal Account Bank Transfer BANK TRANSFER Tokyo Mitsubishi Bank Branch Oji Shiten #175 “Global Business Resources Corporation” Regular account # 1097149 POSTAL TRANSFER グローバル ビジネス リソーシズ コーポレーシヨン Account #10110-47172231 Payment Date Signature * To process orders, bank transfer or postal transfer receipt must be attached.