Secure Mode (SSL):
This form is encrypted in transit for safe online transactions


TO ORDER YOUR OWN Moderated-Chat:
Monthly Rate: $29.95 (then free access for visitors)
+ ONE-TIME 49.95 set-up

CHOOSE A NAME FOR YOUR CHAT ROOM:
Name of your Chat Room

YOUR EMAIL for contact purposes:
Your email

SELECT BACKGROUND COLOR (click the circle in appropriate box):
Ivory Dust Sun Earth Sky Ocean Electric Rose
- To select a different background, please specify in COMMENTS box.


SELECT HOW LONG TO SAVE EACH CHAT MESSAGE:
Save messages for 1 hour
Save messages for 1 day
Save messages for 7 days
Save messages for 14 days
Save messages for 30 days


SELECT HOW MANY PEOPLE CAN LOGIN SIMULTANEOUSLY:
(how many can chat at the same time)
Up to 15 people (free)
Up to 25 people (+ $10/mo.)


SELECT TIME ZONE:
Eastern U.S. Central U.S. Mountain U.S. Pacific U.S. Other:

REGISTRATION OF USERS:
People will create their own usernames and passwords
The moderator will create usernames and passwords for everyone


ADD-ONS TO ENHANCE YOUR CHAT ROOM:

User-Block - Block unwanted users from your chat room instantly using an easy web-based form. (free)
Line Dividers - Insert a line between each message. (free)
Message-Delete - Delete all your chatroom messages instantly with the click of a button. (free)
On / Off Switch - Turn your chatroom On or Off at anytime, enabling you to control when people can access your room. (free)
Message-Banner - Add your own banners or messages and both at your chat entrance and inside the chat room. You can change or add to your banner or message anytime instantly using an easy-to-use Web form. (free)
Visitor Counter - Add a counter to the bottom of your chatroom entrance that displays how many people have accessed your room. (free)
Time Stamp - the time is displayed next to each message posted, great for stock trading and auction chat rooms. (9.95 one-time fee)
SSL Chat - We host your chatroom on a Secure Server Layer (SSL) which encrypts your chat sessions in transit using state-of-the-art 128 bit encryption. (+ $15/month)


CHATROOM OWNER INFO:
Please list a contact name and e-mail or website address to appear as the chatroom owner on the opening screen.
Owner Name (nickname or company name is ok)
Owner E-mail OR Website Address


PAYMENT INFO:
Method:
Cardholder:
(First name, Last name)
Billing Street Address:
City, State, Country
Zipcode:
Phone Number:
Card Number:
(xxxx-xxxx-xxxx-xxxx)
Expiration Date:
(mm/yy)
3 Digit Code on back of card:
(if present)
How did you find Online Institute LLC:
Keywords you used:
(if you found us through a search)
Briefly describe purpose of chatroom:


MONTHS ORDERED: + one-time 49.95 set-up
1 month = $29.95
2 months (10 percent discount) = $53.90
3 months (15 percent discount) = $76.35
6 months (20 percent discount) = $143.75
1 year (25 percent discount) = $269.55


RENEWAL:
Automatically renew the chat room unless I cancel
Do not renew the chat room after initial period

COMMENTS - include any text or images (with URLs) to add to your room:


USAGE AGREEMENT:
I agree to abide by the Usage Agreement to use this service.
Yes, I agree
No, I Disagree



A technician will verify your order before your chatroom is installed.





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