Web Hosting Order Form/title> <meta name="description" content="" /> <meta name="keywords" content="" /> <link rel="stylesheet" type="text/css" href="css/balinter.css" /> <script type="text/javascript" src="js/script.js"></script> <script language="JavaScript"> function valit() { var var1=document.cek.domainname1.value ; var var2=document.cek.name.value ; var var3=document.cek.organisasi.value ; var var4=document.cek.jabatan.value ; var var5=document.cek.alamat.value ; var var6=document.cek.kota.value ; var var7=document.cek.kodepos.value ; var var8=document.cek.telepone.value ; var var9=document.cek.fax.value ; var var10=document.cek.email.value ; var var11=document.cek.pesan.value ; if ((var1=="")||(var1==" ")) { alert("Isi Nama Domain Anda"); return false; } else if ((var2=="")||(var2==" ")) { alert("Isi Nama Lengkap Anda"); return false; } else if ((var3=="")||(var3==" ")) { alert("Organisasi Atau Istansi Anda"); return false; } else if ((var4=="")||(var4==" ")) { alert("Jabatan Anda"); return false; } else if ((var5=="")||(var5==" ")) { alert("Alamat Lengkap Anda"); return false; } else if ((var6=="")||(var6==" ")) { alert("Kota Anda"); return false; } else if ((var7=="")||(var7==" ")) { alert("Kode Pos Anda"); return false; } else if ((var8=="")||(var8==" ")) { alert("Nomor Telepon yang bisa dihubungi"); return false; } else if ((var9=="")||(var9==" ")) { alert("Nomor Fax Anda"); return false; } else if ((var10=="")||(var10==" ")) { alert("Email yang masih dipakai"); return false; } else if ((var11=="")||(var11==" ")) { alert("Pesang Singkat Anda"); return false; } else if ((var11=="-blank-")) { alert("tahun lahir"); return false; } return true; } </script> </head> <body> <table width="1044" border="0" cellspacing="0" cellpadding="0" align="center"> <tr> <td width="445"> <div class="toptext"> We are provider of cheap web hosting and VPS hosting services </div> </td> <td width="599" align="right" valign="top" style="padding-right:45px;"> <img src="images/balinter_06.jpg" /> <a href="ymsgr:sendIM?seo_balinter"><img style="padding-top:7px;" align="top" src="http://opi.yahoo.com/online?u=seo_balinter&m=g&t=1" width="64" height="16" border="0" alt="Search Engine Optimization" /></a> <img src="images/balinter_08.jpg" /> <a href="http://www.balinter.net"> <img border="0" src="images/balinter_07.jpg" /></a> </td> </tr> <tr> <td colspan="2"><table width="106%" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="40%" height="97" align="right" valign="top" style="padding-right:110px;"> <img src="images/balinter_04.jpg" /> </td> <td width="60%" valign="top">  <ul class="menu" id="menu"> <li><a href="./" class="menulink"><img src="images/home.jpg" border="0" /></a> <li> <a href="#" class="menulink"><img src="images/web_hosting.jpg" border="0" /></a> <ul> <li> <a href="#" class="sub">Shared Hosting</a> <ul> <li class="topline"><a href="standard_package.html">Standard Package</a></li> <li><a href="bussiness_package.html">Bussiness Package</a></li> <li><a href="premium_package.html">Premium Package</a></li> </ul> </li> <li><a href="#">VPS</a></li> <li><a href="#">Reseller</a> </li> </ul> </li> <li><a href="domain_name.html" class="menulink"><img src="images/vps.jpg" border="0" /></a></li> <li><a href="#" class="menulink"><img src="images/reseller.jpg" border="0" /></a> <ul> <li><a href="domain_reseller.html">Domain Reseller</a></li> <li><a href="hosting_reseller.html">Hosting Reseller</a></li> </ul> </li> <li><a href="#" class="menulink"><img src="images/web_design.jpg" border="0" /></a> <ul> <li><a href="cheap_webdesign.html">Web Design Package</a></li> <li><a href="#" class="sub">Our Portofolio</a> <ul> <li class="topline"><a href="#">Travel & Leisure</a></li> <li><a href="#">Hotels & Villas</a></li> <li><a href="#">Computer & Acesories</a></li> <li><a href="#">Goverment Project</a></li> <li><a href="#">Educations</a></li> <li><a href="#">Miscellaneous</a></li> </ul> </li> </ul> </li> <li><a href="payment_methods.html" class="menulink"><img src="images/payment.jpg" border="0" /></a></li> <li><a href="contact_us.html" class="menulink"><img src="images/contact.jpg" border="0" /></a> </li> </ul>  </td> </tr> </table></td> </tr> <tr> <td colspan="2" valign="top" align="center"> <img src="images/balinter_11.jpg" /> </td> </tr> <tr> <td colspan="2" valign="top" align="center"> <table width="92%" border="0" cellspacing="0" cellpadding="0" align="center"> <tr> <td width="68%" valign="top"> <div id="left"> <h2 class="h2">Web Hosting Order Form</h2> <br /> <table width="98%" border="0" align="center" cellpadding="0" cellspacing="0"> <tr> <td height="164" valign="top"> <div align="justify"> <map name="Map11Map"> <area shape="rect" coords="86,84,147,93" href="paketdesign.html" alt="Bali Info Internet design"> <area shape="rect" coords="91,96,152,106" href="javascript:void(0)" onClick="window.open('pakethosting.html','host','toolbar=0,location=0,directories=0,status=1,menubar=0,scrollbars=0,resizable=0,width=700,height=440,top=1,left=1')"> <area shape="rect" coords="91,107,158,120" href="domain.html" alt="Bali Info domain name"> </map> <font class=TeaserText> </font> <div align="left"> </div> <form name="cek" action="thankyou.php" method="post" onSubmit="return valit()"> <TABLE width=100% border=0 style=border-collapse: collapse bordercolor=#111111 cellpadding=0 cellspacing=0> <TBODY> <TR> <TD width=109 valign=top> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Domain Name </FONT> </p> <P align="left" style=margin-left:10></P></TD> <TD vAlign=top><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT><FONT face=Verdana, Arial, Helvetica, sans-serif size=1> </FONT></div></TD> <TD vAlign=top><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=25 name=domainname1 style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial" value=""> <select name=domainname2 style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> <option value="com">.com</option> <option value="org">.org</option> <option value="net">.net</option> <option value="biz">.biz</option> <option value="info">.info</option> <option value="us">.us</option> <option value="ws">.ws</option> <option value="co.id">.co.id</option> <option value="net.id">.net.id</option> <option value="or.id">.or.id</option> <option value="go.id">.go.id</option> <option value="ac.id">.ac.id</option> <option value="mil.id">.mil.id</option> <option value="sch.id">.sch.id</option> <option value="web.id">.web.id</option> <option value="asia">.asia</option> <option value="com.sg">.com.sg</option> <option value="net.sg">.net.sg</option> <option value="org.sg">.org.sg</option> <option value="name">.name</option> <option value="travel">.travel</option> <option value="in">.in</option> <option value="cn">.cn</option> <option value="jp">.jp</option> </select> </font></TD> </TR> <TR> <TD vAlign=top width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Domain Status </FONT></TD> <TD colspan="2"><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: <INPUT type=hidden value=1 name=txtStatusRegister> <input type=radio value=Baru name=domainstatus checked style="font-family: Arial; font-size: 8pt"> </FONT><FONT face=Verdana, Arial, Helvetica, sans-serif size=1><span lang=en-us>Baru </span></FONT><FONT face=Verdana, Arial, Helvetica, sans-serif size=2><span lang=en-us> </span></FONT><font face=Verdana, arial, helvetica, sans-serif size=2><span lang=en-us> <input type=radio name=domainstatus value=Transfer style="font-family: Arial; font-size: 8pt"> </span></font><FONT face=Verdana, Arial, Helvetica, sans-serif size=2><span lang=en-us><font size="1">Transfer</font></span></FONT></div></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Full Name </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <select name="bapakibu" style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> <option value="Mr">Mr</option> <option value="Mrs">Mrs</option> <option value="Miss">Miss</option> </select> <input maxlength=100 size=35 name=name style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Organization </FONT></TD> <TD><div align="left">:</div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=35 name=organisasi style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Position</FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=30 name=jabatan style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109 valign="top"> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Address </FONT></TD> <TD width=5 valign="top"> </TD> <TD width=360 valign="top"><textarea name=alamat rows=3 cols=35 style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"></textarea></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>City </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=35 name=kota style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Province </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <select name=propinsi style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> <option value='Bali'>Bali <option value='Banten'>Banten <option value='Bengkulu'>Bengkulu <option value='DI Aceh'>DI Aceh <option value='DI Yogyakarta'>DI Yogyakarta <option value='DKI Jakarta'>DKI Jakarta <option value='Irian Jaya (Papua)'>Irian Jaya (Papua) <option value='Jambi'>Jambi <option value='Jawa Barat'>Jawa Barat <option value='Jawa Tengah'>Jawa Tengah <option value='Jawa Timur'>Jawa Timur <option value='Kalimantan Barat'>Kalimantan Barat <option value='Kalimantan Selatan'>Kalimantan Selatan <option value='Kalimantan Tengah'>Kalimantan Tengah <option value='Kalimantan Timur'>Kalimantan Timur <option value='Lampung'>Lampung <option value='Maluku'>Maluku <option value='Nusa Tenggara Barat'>Nusa Tenggara Barat <option value='Nusa Tenggara Timur'>Nusa Tenggara Timur <option value='Riau'>Riau <option value='Sulawesi Selatan'>Sulawesi Selatan <option value='Sulawesi Tengah'>Sulawesi Tengah <option value='Sulawesi Tenggara'>Sulawesi Tenggara <option value='Sulawesi Utara'>Sulawesi Utara <option value='Sumatera Barat'>Sumatera Barat <option value='Sumatera Selatan'>Sumatera Selatan <option value='Sumatera Utara'>Sumatera Utara <option value='Luar Indonesia'>Luar Indonesia</option> </select> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Postal Code </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=7 name=kodepos style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Country </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=35 value=Indonesia name=negara style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1><span lang=en-us>Telepon/HP</span>. </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=35 name=telepone style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Fax. </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=35 name=fax style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD vAlign=top width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Email 1 </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=35 name=email style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD vAlign=top width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Email 2 </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <input maxlength=100 size=35 name=email2 style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> </font></TD> </TR> <TR> <TD width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Hosting Package</FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <select name=hosting style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> <option>Silahkan Pilih : <option value=0>10 MB (2rb/bln) <option value=1>25 MB (3rb/bl) <option value=2>50 MB (12,5rb/bl) <option value=3>100 MB (20rb/bl) <option value=4>150 MB (26rb/bl) <option value=5>200 MB (29rb/bl) <option value=6>250 MB (31rb/bl) <option value=7>500 MB (52rb/bl) <option value=8>1000 MB (68rb/bl)</option> <option value=9>1500 MB (75rb/bl)</option> <option value=10>2000 MB (85rb/bln)</option> </select> </font></TD> </TR> <INPUT type=hidden value=2 name=txtLocation> <TR> <TD vAlign=top width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1> Contract term </FONT></TD> <TD><div align="left"><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>: </FONT></div></TD> <TD><font face=Verdana, arial, helvetica, sans-serif size=1> <select name=kontrak style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"> <option selected>Silahkan Pilih : <option value=12>12 bulan <option value=6>6 bulan <option value=3>3 bulan <option value=1>1 bulan </select> </font></TD> </TR> <TR> <TD vAlign=top height=18> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Note </FONT></TD> <TD height=18 vAlign=top><font color="#FFFFFF" size=1 face=Verdana, arial, helvetica, sans-serif>:</font></TD> <TD height=18 vAlign=top><font face=Verdana, arial, helvetica, sans-serif size=1> <textarea name=pesan rows=5 cols=30 style="background:#ffffff;border-style: solid; border-width: 1px; color:#339900 ;font-size:8pt;font-family:Arial"></textarea> </font></TD> </TR> <TR> <TD vAlign=top height=15> </TD> <TD height=15 colspan="2" vAlign=top><font face=Verdana, arial, helvetica, sans-serif size=1><font color=#333333> </font>Silahkan isi pesan bila anda membutuhkannya. </font></TD> </TR> <TR> <TD vAlign=top height=15> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Security Code</FONT></TD> <TD height=15 colspan="2" vAlign=top><font face=Verdana, arial, helvetica, sans-serif size=1> :<img src="captchasecurityimages.php?width=80&height=20&character=5" align="absmiddle"> </font></TD> </TR> <TR> <TD vAlign=top height=24 width=109> <p align="left" style=margin-left:10><FONT face=Verdana, Arial, Helvetica, sans-serif size=1>Enter your Security Code</FONT></TD> <TD height=24 vAlign=top> <font face=Verdana, arial, helvetica, sans-serif size=1>: </font></TD> <TD height=24 vAlign=top><font face=Verdana, arial, helvetica, sans-serif size=1> <input name="security_code" type="text" id="security_code" size="10" maxlength="6" style="font-family: Arial; font-size: 8pt"> </font></TD> </TR> <TR> <TD vAlign=top colSpan=3 height=68> <p align="justify" style=margin-left:10> <INPUT type=checkbox value=keberatan name=agree style="font-family: Arial; font-size: 8pt"> <FONT face=Verdana, Arial, Helvetica, sans-serif size=1> By filling this information sheet you agree with the terms and conditions which can be found on following website link : <a href=aturan.html?id=010>Agreement</a></FONT><BR> </FONT></p> </TD> </TR> <TR> <TD width=109> <p align="left" style='margin-left: 10'></TD> <TD colspan="2"><div align="left"><BR> <FONT color=#333333> </FONT> <input type=submit value=Daftarkan name="B1" style="background:#000000;border-style: solid; border-width: 1px; color:#ffffff ;font-size:8pt;font-family:Arial"> <input type="reset" value="Reset" name="B2" style="background:#000000;border-style: solid; border-width: 1px; color:#ffffff ;font-size:8pt;font-family:Arial"></div></TD> </TR> </TABLE> </FORM> </div></td> </tr> </table> </div> </td> <td width="1%"> </td> <td width="31%" valign="top"> <div id="right"> <center><h2 class="h2-green">News Updated</h2></center> <ul class="vert-one"> <li><a href="news_8_cheap_and_best_web_hosting.html"><img border="0" src="images/arrow.jpg" align="absmiddle" /> Cheap And Best Web Hosting</a></li> <li><a href="news_12_web_hosting_for_beginners.html"><img border="0" src="images/arrow.jpg" align="absmiddle" /> Web Hosting For Beginners</a></li> <li><a href="news_13_choosing_a_proper_web_hosting.html"><img border="0" src="images/arrow.jpg" align="absmiddle" /> Choosing a Proper Web Hosting</a></li> <li><a href="news_14_world_class_web_hosting_service.html"><img border="0" src="images/arrow.jpg" align="absmiddle" /> World Class Web Hosting Service</a></li> <li><a href="news_15_nokia_n9_everything_swipe.html"><img border="0" src="images/arrow.jpg" align="absmiddle" /> Nokia N9, Everything Swipe</a></li> <li><a href="news_16_bali_hospital.html"><img border="0" src="images/arrow.jpg" align="absmiddle" /> Bali Hospital</a></li> </ul> </div> <div id="right"> <center><img src="images/balinter_19.jpg" /></center> </div> </td> </tr> </table> </td> </tr> </table> <div style="height:60px;"></div> <div id="pink"> <table width="86%" border="0" cellspacing="0" cellpadding="0" align="center"> <tr> <td valign="top"> <img style="padding-left:28px;" src="images/balinter_22.jpg" /> </td> </tr> </table> </div> <div id="footer"> <table width="86%" border="0" cellspacing="0" cellpadding="0" align="center"> <tr> <td width="20%" valign="top" style="padding-left:85px;"> <img src="images/balinter_28.jpg" /> </td> <td width="80%" valign="top"> <img src="images/balinter_30.jpg" /> </td> </tr> </table> </div> <script type="text/javascript"> var menu=new menu.dd("menu"); 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