Power Phlogger Web Tracking Sign-Up Form

To signup for website tracking, just fill out the form below and click on the submit button.

Our Power Phlogger Web tracking service costs 199.95 per year, with a one time 49.95 setup fee. However if you are a CIIC Web Design or Web Hosting client there is a discount (it is even included free with some of our hosting packages). Fill out the form below and we will contact you before any thing is charged to your credit card.

If you are not a CIIC client you will need to supply FTP access information for your website. You can still fill out this form and we will contact you if we need any additional info.

In either event we will install the tracking code on your site and send you your username and password to log into the system.

Contact Information:

Your name:

Your title:

Company:

Your e-mail address:

Daytime phone:

Fax:

Web Address To Be Tracked :

FTP Server Address :

FTP Username :

FTP Password :
 

Payment Information:

*Select Payment Type:
Site will not be live until payment arrives and clears if paying by check.

Credit Card Number:

Credit Card Expiration Date:

Exact Cardholder Name:

Credit Card Billing Address:

Billing Address Line 2:

*Billing City:

*Billing State/Province:

*Billing Zip/Postal Code:

*Billing Country: