KARINYA REGISTRATION/INTEREST FORM
If You Need Information Please Call: 480 899 4463 USA, Monday-Friday, or
Complete and Mail or Fax This Form To: Larry Smith, 3619 E Verdin Rd, Phoenix AZ 85044 USA,
(Use additional sheets if necessary) 
REGISTRANT:
Name _________________________________________________________________

Address ______________________________________________________________

City _________________________ State ________________Zip _____________

Country ______________________ Phone _________________________________

E-Mail Address _________________________________________________________________

Fax # _____________________  800 # _________________________ 


(For interest only the below data is not required)
Do you wish to accept 
any of the following:  [  ] VISA	[  ] MasterCard
[  ] Discover  [  ] American Express   [  ]  Check	[  ] Money Order	

Can you describe your business and focus _______________________________________________
_________________________________________________________________________________________


Do you want to have any of the following options:
Option
Description
Cost
TOTAL
(U.S. Funds)
Access
Name of an access provider
(FREE)
(FREE)
Full Graphics
(Option)
Complete full graphics or separate page (One-time)
$750.00

Graphics (Option)
Provide more punch and pizzazz with a logo
or simple graphic, per month
$10.00


Fee
Basic monthly fee - storage/server costs
$10.00
$10.00
Fee
Basic monthly fee - listing -Includes server
$60.00
$60.00
Initial Fee
Initial sign-up and set-up (One-time - no web page)
$75.00
$75.00
Brochure (Option)
Three-fold brochure which can be used for
advertising your Karinya site (Master copy only)
$250.00

Changes
Unlimited changes to your listing with a
minimum of $35.00 per hour
$75.00
To be billed
On-Line (Option)
On-Line ordering enabling orders to be taken as viewers see your page - per month
$10.00


Mail-To
Mail-To Form enabling viewers to
laser print an order form and mail later
FREE
FREE
Infomation
Brochures
Information Brochures about Karinya
FREE
FREE
 
    Basic Monthly Total $60.00 +Option(s) __________ = Total Order____________
Confirmation of and accceptance and draft of your page or listing will be made via mail or e-mail.
Thank you for your interest and your registration form for KARINYA
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