April 4, 2016 anth Order Customer InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Email* PhonePalace InformationService Level*Starter - $5Essentials - $10Preferred - $15Premium - $20Please choose the desired package. You may upgrade your service level at any time during your service period.Palace Address*I will provide my ownChoose my own subdomainYou may choose to use your own registered domain (cheryls-palace.net), or you may choose a custom address under one of our own (joechat.ssws.us).Your domainSubdomainThe host portion of your address, e.g. atlantis in "atlantis.ssws.us".Domainssws.ussharpsphere.comsharpsphere.netThe domain portion of the address. In "atlantis.ssws.us" this is the ".ssws.us" portion. If you want to use your own domain, change the Palace Address option above to "I will provide my own".Palace NameThe name of your Palace. This is used for the initial template configuration as well as the directory listing, if requested.List site on the Palace Portal directory*YesNoSelect this option if you wish to list your Palace on the community-sponsored Palace Portal live directory.Starting Rooms File*Fresh start (1 room)Starter template (16 room starter)Use my own rooms fileTransfer from another hostChoose the starting room file for your Palace.Rooms & Media upload Drop files here or If you wish to provide your rooms and media files, you may upload them here. Please upload in a compressed format (zip, tgz, 7z, etc.)E-mail accounts (optional) Price: $10.00 Quantity: If you would like us to host e-mail accounts at your provided address, please specify the quantity.Example: email@example.com (or) firstname.lastname@example.orgSubscription TotalTotal $0.00 CaptchaAcceptable Usage Policy*By submitting this form I consent to have thoroughly read, understand, and comply with the terms and conditions stated in Sharp Sphere's Acceptable Usage Policy. I have read, understand, and will comply with the terms and conditions stated in Sharp Sphere's Acceptable Usage Policy. This iframe contains the logic required to handle Ajax powered Gravity Forms.