Website Registration Form
Jax Computers Inc. DBA JLA Associates
WWW.JLAJAX.COM
JLA@JLAJAX.COM

JLA Associates JAX Computers
950-23 Blanding Blvd #287
Orange Park, Florida 32065

Phone: 904 298 2533

Please complete one form for each account requested.
Authorized User or Administrator

First Name MI. Last Name Title

Company/Organization

Street Address

FAX:

City, State, ZIP

Day Phone: Evening Phone:

Amount Due Per Billing Cycle

Total Start Up Fees

Domain Name Choices (List Three)

Deposit:

I have read all the pages of this agreement and agree to JLA Associates Service Agreement and Operating Rules. I further authorize JLA Associates/JAX Computers Inc. to access and maintain my website. This authorization is valid until revoked in writing. I agree that payment is due within 10 days of completion of work or is to be divided into _____ monthly payments in the amount of. I agree to pay any and all expenses associated with this account including any collections or legal fees.

Signature:

Date: