Welcome to the ResultImaging.com Sponsor Website Program!

Personal Information

Company Name: *
Contact First Name: *
Contact Last Name: *
Address: *
City: *
State: *	[ Select ] AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code: *
Phone: *
Cell Phone:
Fax:
E-mail: *
Other E-mail:
Spoke to Salesman:	- No - Yes [ If Yes, please select ] Mark Rhodus

Site Building Instructions

(a) Do you have an existing website? - No - Yes (if Yes enter it below) Website: http://

(b) Do you have an existing Domain Name? - No - Yes (if Yes fill the fields below) Domain Name: Domain Registrar: (c) If not, list three potential domain names: 1. 2. 3.

(d) Do you have a company logo already? No Yes

(e) Do you have photos of your work? No Yes

(f) List three design color choices in order of preference: 1. 2. 3.

(g) Select a design theme that best matches your company: [ Select ] Traditional Craftsman Corporate/Commercial Natural/Organic Contemporary Artistic Elegance

(h) Please describe your company, services and products:

(i) List 5 or 10 of your top selling products:

(j) Enter the Counties you service:

(k) Enter the Zip Codes you service:

Payment

Choose a Payment Method: Credit Card (monthly) Electronic Check (monthly) Company Check (12 months advance) Notice of Conditions Clients paying via Credit Card pay first month + last month in advance. Check payments must be paid for 12 months service in advance.

Billing Address Same Address as above Name: Address: City: State: Zip:

Service Terms

Our Service Terms Thank you for your interest in our Web Site Program. Below is a list of our Service Terms and Conditions that must be agreed to, by you, in order to be approved. 1. You hereby acknowledge and understand that you are engaging into this Service Terms and Conditions agreement for the design, building, hosting and management of your new web site, which has been promoted to you via this authorized Clear Imaging Affiliate Partner's (Reseller) web site. Clear Imaging will be the primary developer of your new web site, and will be responsible for the initiation, fulfillment, maintenance and billing charges. The Affiliate Partner (Reseller) is not a part of Clear Imaging, Inc., rather they are an independent company or an individual that has been authorized by Clear Imaging to promote this web site program. The Affiliate Partner (Reseller) will not be held liable or responsible for any issues or disputes in relation to your web site. 2. You authorize Clear Imaging, Inc. to charge your credit card, checking account or debit card for first and last month’s payment (2 months) upon the commencement of your web site project. Generally, this first charge occurs on the 15th day of the current month if the sign up date is between the 15th to the 22nd of the current month. If you sign up after the 22nd of the month, your first and last month’s payment will roll over to the next month on the 15th. 3. You understand that this Web Site Program is based on ongoing payments over a 5-year period, at which point you will then own the web site outright, including all copyrighted materials and contents. You will have the option to discontinue services at that time, or choose to continue our services on a month-to-month basis. However, if we provide you with a complete new web site redesign and rebuild for free, at any stage within this initial 5-year period, the service terms will restart for an additional 5-year period. 4. You agree not to cancel your web site and payment within the first 12 months of your web site "Live" date. You also agree that there are no payment refunds or charge-backs after you have been charged, regardless of the reason whatsoever. 5. You understand that if you do cancel your web site and payment within 5 years of your web site "Live" date, you will not be able to take ownership of the web site design or it's copyrighted contents. The only option would be for you to pay the remaining balance of the 5 years service fee, before we would release the copyrighted materials and completed web site to you. You understand that we will not provide FTP access to the website until the end of the 5 year payment plan. 6. You understand that if you do cancel your web site and payment within 5 years of your web site "Live" date, you will not be able to take ownership of the web site domain name, unless you had registered it yourself via a third party registrar. If we register your domain name, you would have to pay a $100 domain name transfer fee before we release the domain name to you. At that time we will transfer the domain name and ownership to you through the domain registrar. 7. You understand that all minor web site changes and updates are included as part of your monthly fee which includes, web site hosting, e-mail accounts, storage and bandwidth. However, major web site changes and updates such as a complete web site re-designs, major navigational changes, database driven applications or e-commerce integration will require additional charges based on the complexity and time needed to accomplish them, which will be determined by Clear Imaging in a Web Scope Outline upon request. Before any work is started, there will be an agreement upon price. 8. You understand that your monthly payments will be used primarily to pay for your web site over a 5 year period, which includes minor site updates, basic "Organic" search engine optimization on major search engines, such as google and yahoo and print design services, based on your web site plan. 9. You understand that your monthly or yearly Payments will be charged via Clear Imaging, Inc., by Credit Card, Electronic Check or Regular Check, depending on your preferred method of payment and web site plan. 10. You hereby agree to abide by all the above Service Terms and Conditions before signing up for any of our web site plans. By continuing forward, you are agreeing to all of our Service Terms and Conditions as written here. Clear Imaging reserves the right to change or update these Service Terms and Conditions at any time without prior notice. Should this happen you will be notified when you log into our Support Ticket System. You will always be “grandfathered” in, to the terms you signed, which will override any future changes made to these Service Terms and Conditions. We recommend you print a copy of these existing Service Terms and Conditions by clicking the link, provided to the right side of this box. Clear Imaging, Inc. 711 S. Carson St. Carson City NV 89701 Phone: 800-380-6942 - I Agree Service Terms and Conditions Print Service Terms and Conditions

Enter security code (Ensures secure transmission of your info): Please, enter the 4 digit code in the field below and then click the "submit" button.

By clicking on the "Continue" button you hereby agree to abide by our Service Terms and Conditions before signing up for any of our Program service plans.