To sign up for our death care website service by mail, print and complete this form, then mail with payment to:

Hilltop Web Services
DEPT: 82
2463 Barnes Mill Rd.
Richmond, KY 40475

Please make checks payable to Hilltop Web Services.

After receiving your form and payment, we will contact you within 2 business days to help you choose a site template and colors, and activate your account.

 

Full Name __________________________________________
Company Name __________________________________________
Address __________________________________________

__________________________________________
City, State, Zip __________________________________________
Phone # __________________________________________
Email Address __________________________________________
Domain Name Status
(check one)		 [ ] I already own my domain name, and would like Hilltop to help me transfer it. My domain name is listed below.
[ ] I do not own a domain name, and would like Hilltop to help me register one. My first three choices are listed below.
[ ] I will take care of domain names myself.
Domain Name Choices Choice 1: __________________________________

Choice 2: __________________________________

Choice 3: __________________________________
Subscription Period
(check one)		 [ ] One year: $359.40 ($29.95 x 12 months)
[ ] Six months: $179.70 ($29.95 x 6 months)
Terms and Conditions [ ] I agree to Hilltop terms and conditions, as stated in the Terms and Conditions document.
Signature
Date		 _______________________________________
_________