First Name:    Last Name: Current Email Address:

Billing Address:

 

Street: Suite/Apt.

City: State:          Zip Code:         

Company Name: Phone: Alternate Phone:

How did you hear about us?:

Domain Name: Existing Domain:  Yes No (If yes, you will need to update the nameservers where with the company you registered your domain. You will receive the nameserver information as soon as your account has been set up)

If no, do you want us to register the domain for you?  Yes  No (be sure you include the extension .com, .org, etc)

Note: Registering your domain on your own will cost around $12 for one year. If you have us register for you, we charge a fee of $10 in addition to the domain fee.  If you need help choosing a name, please put that in the notes with some key words pertaining to your new web site and we will help with some suggestions.)

Please enter 2nd and 3rd Domain choice in case the one you chose is not available:

2nd Choice: 3rd Choice:

Do you want Front Page Extensions Installed?  Yes    No

Initial Email Account: @

Temporary Password: (Must be a minimum of 8 characters with a Capital letter and number)

Select Hosting Plan:          Please Select One Pearl Topaz Emerald Diamond Select Contract Length:          Please Select Payment Plan One Month Three Months Six Months One Year

Note: There is a one-time set up fee of $25.00

If you chose to have us register your domain there will be an additional $10.00 fee for us to register the domain for you.

 

Once we have received your order, we will send a PayPal request for payment to the email address you entered above. Once payment is received your hosting service will be set up and available to start using within 24 hours to 48 hours.

I have read, and agree to the Terms of Service