Colocation Order Form Required fields labeled in black. CUSTOMER INFO Your Name: Business Name: Billing Address: Address 1: Address 2: City: State Zipcode: Phone: E-Mail Address: SELECT COLO PACKAGE I would like the following colo package: Select a package: Select one Colo 1 @ $149/month Colo 2 @ $279/month Colo 3 @ $399/month Custom/Other (describe below) Custom/Other (Please describe*): *The pricing for custom colo will be determined by opus:interactive. You will be provided with an estimate based on your specific colo needs. BILLING Bill me every: Month 6 Months (semi-annually) Year (annually) I would like to pay by: Credit Card Check Pay Pal each month How did your hear about us? Google Ad Google Search MSN Yahoo Advertisement opus:interactive Sales Person other (please specify below) Other:   Notes: Please add any information that will help us fullfill your order: Special Code: (optional) (i.e. Discount, Partner, or Referral Code.) *opus:interactive will contact you to verify the details for each additional options you wish to order.

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