WEBSITE HOSTING ORDER FORM
Subscriber Information:
First Name *

 Last Name *
Fields denoted with * are required.

A company name is required in order to create or transfer a .com, .net, .org or .edu domain with Network Solutions (InterNIC). If you do not have a company name, use your full name.

If you are transferring your domain, you must list your company name exactly as it was registered with InterNIC.

International domains must be separately registered.

Company Name *
Phone *
 Fax
Address Line 1 *

Address Line 2
City *
 State/Province *
 Zip/Postal Code *
Country *
E-Mail Address *
Payment Method
Credit Card

Account Information:
Domain Name *

For a new domain
I will transfer my domain

Register Domain
If the above is checked, we'll register your domain for a one time fee of $20, however, this fee will be waived if your hosting account remains for the second billing period (or 4 months). There is a separate $10 yearly fee charged by the domain registrar, later, you'll need to provide credit card information to pay this directly.
Plan
 		Length
 months

Server Platform
Windows 2000

Additional Notes