WEB
SITE HOSTING ORDER FORM |
First
Name |
|
Last
Name |
|
Company
Name (optional) |
|
E-mail
Address |
|
Mailing
Address (as it appears on your credit card bill) |
|
Apartment
or Suite |
|
City |
|
State/Province |
|
Zip/Postal
Code (as it appears on your credit card bill) |
|
If
outside the U.S. what country? |
|
Home
area code & phone number |
|
Work
area code & phone (optional) |
|
PAYMENT
INFORMATION |
Which Credit Card
will you use for payment? |
|
Credit Card Number: |
|
Expiration Date: |
|
Name on Card: |
|
INFORMATION
ABOUT YOUR ACCOUNT |
Enter
your domain name |
|
Is
this a new web site or a transfer of an existing web site? |
|
What
Password would you like for your account? |
|
How
much storage space do you want? |
|
I agree to your
policies as stated on the policies page. |
Yes
No |
Comments, if any |
|
|