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Referral Form

Check Referral Status
>home/affiliate/details Sunday, August 28, 2005    



Referral Form

Just fill out the form below to have your referral registered with SelectNet. The referral will be good for 60 days. When/if your referral signs up as a new customer to SelectNet, make sure you ask them to enter your domain name on their Internet Services Order Form so you will receive credit! Without your domain name on the form, we can not issue you or the new customer the referral credit.

About You:
Your Name *
Your Phone Number
Your E-mail *
Your Domain *
 
About Your Referral:
Your Friend's Name *
Your Friend's Phone Number *
Your Friend's E-mail

Your Friend's Domain
 
What SelectNet services would most interest your referral?
Web Hosting
E-Commerce Hosting
Media Hosting
Web Design
Colocation
Internet Access

Comments:

Note: The information on this form will be e-mailed to you as confirmation we received it. If you do not receive this confirmation within a few hours, please give us a call at 760-438-9555. There may have been problems with the transmission.



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