Easy Web Store (TM)
Service Registration Form

Enter the domain name that you registered for your Easy Web Store.

Domain Name:

Enter the password you wish to use to login to your Easy Web Store.

Password:

Retype Password:

Contact information will be used by Pan Orange to contact you.

Contact Name:

Contact Phone:

Contact Address 1:

Contact Fax:

Contact Address 2:

Contact E-mail:

Contact City:

Contact State:

Contact ZIP:

Business information will be displayed on your web site.

Business Name:

Business Phone:

Business Address 1:

Business Fax:

Business Address 2:

Business City:

Business State:

Business ZIP:

Please provide a logo (from a business card, computer file, etc.) to be used on your store banner.

(If you don't have a logo in electronic format, mail a printed logo to Pan Orange.)

Logo File:

Please enter your credit card information.

Name on Card:

Card Type:

Billing Address 1:

Card Number:

Billing Address 2:

Card Expiration Date:

Billing City:

Card Verification Number:

Billing State:

Card Issuing Bank:

Billing ZIP:

Please provide the following information for each state in which your company must pay sales taxes.
State:	Tax Rate:	Tax on shipping & handling?:
State:	Tax Rate:	Tax on shipping & handling?:
State:	Tax Rate:	Tax on shipping & handling?:
State:	Tax Rate:	Tax on shipping & handling?:
State:	Tax Rate:	Tax on shipping & handling?:

If you were referred by an Easy Web Store member, please enter their referral code.

Referred By:



By clicking the Submit button I acknowledge the following: I have read and agree to the Pan Orange, Inc. Easy Web Store Terms of Service, Pan Orange Store Guidelines, Pan Orange Privacy Policy, PayPal Policies, and Planet Domain Policies; I agree not to change my PayPal e-mail address settings; I agree not to change my PayPal Instant Payment Notification settings; I agree to verify and/or correct, and keep current, my PayPal sales tax settings; I agree to pay applicable sales taxes for sales on my Easy Web Store; I agree to list, and keep current, my contact information on my Easy Web Store; I agree to state my Privacy Policy on my Easy Web Store; I agree to state my Return/Refund Policy on my Easy Web Store; ~~I agree to pay Pan Orange, Inc. the initial Easy Web Store set up fee of $1000.~~ Pan Orange, Inc. agrees to waive the entire set up fee of $1000. I agree to a 12-month contract of service for Easy Web Store. I agree to pay Pan Orange, Inc. $99.95/month plus 1% of transactions for 12 months. Early termination of the 12-month contract will result in a fee equal to 6 months of service or the remaining time on the 12-month contract, whichever is less. After 12-months of service, my Easy Web Store continues on a month-to-month basis. I agree to pay PayPal for all payment processing fees, which are currently 1.9% + $0.30 per transaction to 2.9% + $0.30 per transaction, depending on sales volume.