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UBU Design: Solutions     Hosting Request Form     Please indicate which package you like to sign up for     Hosting package Basic Package $25/Mo. Bussiness Package $50/Mo. Advance Package $70/Mo. Managed Private Server $500/Mo. Company information     Full Name Company E-mail URL Telephone Fax Address City State Country Zip code:     Billing information     Credit card information along with any special request.   Include cardholder's name, card type, number and exp. date Or you may send a check to: UBU Design 2344 28th Street Santa Monica, CA 90405 Please make sure you include your email address and company information. We will contact you as soon as possible and go over the details of your account.