Phoenix Digital Media
Create Your Account
 It's easy to get started with Phoenix Digital Media and only takes a few minutes of your time to sign-up!

Opening a client account is the first step in establishing our relationship. You are under no obligation to purchase services and may cancel any time. We welcome you as a client and look forward to working with you.

To get started now read through our POLICIES, TERMS AND CONDITIONS (below), digitally sign that you have read, understand and agree to them then complete and submit the registration form.



please check box
*I Have Read, Understand and Agree to the
      Phoenix Digital Media Policies, Terms and Conditions.
*Full Name and Title (digital signature for policies, terms and conditions):

* = required

All fields must contain content, write 'n/a' if not applicable.

Contact Information
Company Name: *

Current Website: *
Type 'n/a' if not applicable.

Company Email Address: *

Complete Physical Address: *
(street, PO Box, city, state, zip)

Complete Mailing Address; Street, PO Box, City, State, Zip: *
If same as above type 'same'.

Contact Person Name and Title: *

Contact Person Email Address: *
(Remember this! Username for client login)

Contact Person Phone Number(s): *

Billing Information
Billing Person's Full Name and Title: *

Complete Billing Address; Street, PO Box, City, State, Zip: *
If same as above type 'same'.

Billing Email Address: *


* Please Select a Web Package
Bronze Web Package (Basic Website)
Silver Web Package (Intermediate Website)
Gold Web Package (Advanced Media Website)

* Please Select a Method for Payment
(If paying online, Please have your credit card and PayPal account information ready)
I Will Pay Online by Credit Card with PayPal
I Will Pay by Check, Invoice Me by Email at the 'Billing Email Address' Listed Above
I Will Pay by Check, Invoice Me by Regular Mail
(Note: An additional charge of $2.50 per month will apply for regular mail invoicing)
I am a Winner of a Website

Pre-Designed Website Styles
Insert Pre-Designed Website Style Name (ie: Matthew-Scarlet)
(Note: If you are not using a Pre-Designed Website Leave this area blank)



* Security Image:
security image


(Enter Security Code)

Need a copy of this page for your records?


Note: Web Services Will Begin as of Today's Date - May 23, 2013.

~ ~ ~ ~ ~ ~
Thankyou for selecting Phoenix Digital Media to build and manage your web site.
We are excited about your ministry and are looking forward to serving you.