This section pertains to the merchant (the online store and company running the store). Please fill
out information that is related to who you are and how a consumer can contact you in the event of
any further inquiries. This information should also be on your web site, but we include it in
the Order Acknowledgement that is e-mailed to each of your customers.
NOTE: If you are an agent, ISP or web designer filling out this form for your client, specify the
client information here. You can specify your details in the next "Agent Information" section if appropriate.
(include area code)
Do you need web hosting?
(please select) YES NO Let's talk about it
Your web URL:
(if already online)
What do you want to sell online?
(select one) Books/Publications Clothing Food/Spices/Sauces Adult Products
Accomodations Event/Tour Tickets software/Digital Information
Professional Services Other Services MLM/Network Marketing Gifts & Novelties Housewares Flowers Crafts & Supplies Business Products Electronics Other Merchandise
Please describe your products/services:
How many products do you sell?
(an approximation is fine)
Where did you hear about us?
(select one) E-Mail Newsgroup Friend/associate ISP/Consultant Web Search An online reference Other
Any more info on how you were referred here:
This section pertains to the agent (where appropriate) or the billing contact for the VOE services. If you
are a web designer, ISP, or other agent providing information on a VOE account, please fill out the
information below. Also fill the information below if you wish the billing for the VOE to be sent to
someone other than the merchant/address listed above.
Bill the merchant listed above directly
Bill the agent/contact listed below
No Agent - You're dealing directly with the merchant - billing info below
(include area code)
How would you categorize yourself?
(select one) Individual merchant An ISP A Web Developer/Consultant Webmaster Mall Operator Other Agency
What's the best way to contact you?
(select one) E-Mail Telephone
Please select information on exactly what services you desire. Below is by no means a complete list of all
the services ICorp can provide, but mainly relate to VOE features or associated services. Please feel
free to outline any additional services you may require - our goal is to make sure your venture is
For info see the
What services are you interested in? (check all that apply)
Basic VOE Package
Extended VOE Package
Database VOE Package
Custom headers & footers
PGP E-Mail encryption
Secure Web Order Pickup
Other CGI/Script Services (ad rotation, guest books, counters)
How are you handling shipping charges?
charge per item based on total purchase amount based on weight based on method based on destination varies no shipping charges (part of price)
If you are calculating shipping based on total weight or amount of order,
please provide the 'look-up table' below. Here's an example:
Amount of Order: Shipping:
20.00 5.00 (orders from $0-$20 incurr $5 shipping charge)
40.00 8.00 (from $20.01-$40.00 = $8 shipping)
9999.00 25.00 (anything from $200.01-up is $25 shipping)
What E-Mail address are orders to go to:
What Credit Cards do you accept?
(check all that apply) MasterCard/VISA
If you desire, provide credit card information below and we can use
this to take care of initial payment for services (NOTE: nothing will
be charged until we talk with you and make sure that you're happy
with the proposed arrangement and pricing - this is just for convenience).
Your Credit Card:
MC/Visa American Express Diner's Club Discover
Name on Card:
Enter any other comments on your application, or features or
inquries regarding our service you may have: