Domain Hosting Order Form

OK, let's find out all about you! Basic stuff first:

Please give us the name under which this account should be entered in our books. If a corporation is paying, give us the name of the corporation. If you're an individual acting on your own or for your business, put your name here.

Modeled after the InterNIC's system, we maintain as many as three contacts for any account. It's OK if they're all the same person, in fact, we usually expect them to be one person. We ask in case someday we find we need the flexibility and we don't want to look at our database and see it incomplete.

Administrative Contact

First, the administrative contact. This is probably you. If you are a consultant acting on a client's behalf this may be your client instead.

Name:
Address 1:
Address 2 (may be blank):
City:
State/Province/etc.:
ZIP/Postal Code:
Country:
Telephone:
Fax:
Existing e-mail address:

Technical Contact

Now, the technical contact. This is our day-to-day contact, in as much as we need to be in touch with you from day to day.

If this is someone else, uncheck the box and fill in the data for the technical contact below.

	Technical Contact is the same as Administrative Contact
Name:
Address 1:
Address 2 (may be blank):
City:
State/Province/etc.:
ZIP/Postal Code:
Country:
Telephone:
Fax:
Existing e-mail address:

Billing Contact

Finally, the billing contact. This gives us the address to which we send the bills and who we might call if there's a problem. Yet again, it's likely to be you, and you can skip down again.

If this is someone else, uncheck the box and fill in the data for the billing contact below.

	Billing Contact is the same as Administrative Contact
	Billing Contact is the same as Technical Contact
Name:
Address 1:
Address 2 (may be blank):
City:
State/Province/etc.:
ZIP/Postal Code:
Country:
Telephone:
Fax:
Existing e-mail address:

Now we get to talk about what we can do for you. Which account type do you want us to set up for you?

Basic Business

Payment term:

Monthly Quarterly Yearly

What is the domain name you're going to use with this account?

As soon as the account is set up our nameservers will be answering for that domain name. Getting the appropriate NIC to transfer authority to us is your job, but for info and help if you have a .com, .net, or .org domain, go to the InterNIC's Registration Services.

NOTE: Take advantage of our Domain Registration service (only $15).

Do you want bills sent by surface mail, or email. Please choose one. If you'll be paying by credit card, your card will automatically be billed. (If it's all the same to you, choose email only. It keeps our costs lower, and that's sure to benefit you down the road.)

Surface Mail Email

How did you hear about our service?

Any other comments or concerns?