Please complete the following form completely so we can ensure that your account is setup quickly and correctly.

Note: Before you begin filling out this form and you are registering a new domain name we highly recommend that you check here first to make sure it is available.

General Information Section

Name
Company
Address
City
State/Province     ZIP Code
Country
Telephone
Fax
Email
Email for Billing
UserID Desired         1st Choice
       2nd Choice

Reseller ID
-or- Current UserID

Web Hosting Plan Section

I would like Front Page 98 server extensions.
(Requires an advanced account or higher.)

Domain Name Section

Domain Name
(Enter the full domain name, ie., www.mydomainname.com)

New domain name (we will take care of the registration with InterNIC)
Transfer domain name (we will send you the template to forward to InterNIC)

Did you verify that the domain name is available?. If not, go back to top of page and click on the link to verify your domain name.

If you are transferring an existing domain, we will send you an e-mail template that
you will need to forward to hostmaster@internic.net.

Billing Contact Section

These fields are optional. Blank fields will be filled in with the same information from the General Information Section

NIC Handle If known.
Contact Type
Name
Company
Address
City
State/Province        ZIP Code
Country
Telephone
Fax
Email

Payment Information Section

Method
Card Number
Expiration Date
Cardholders Name
Payment Term
Recurring Payment
  • Recurring Credit Card Charges will occur on or about the 1st of each month with a statement to follow via email.
  • When Paying by check, statements will go to your external email address on or about the 20th of the
    month before payement is due and is due by the 10th of following month.
  • If payment is made by check/money order, your account will be created when the payment is received.
  • Check payments must be made in 12 month increments or higher - discounts will apply.

How did you hear of us?

Before you submit this order go back and check that you entered all required fields accurately. Any information that cannot be determined may cause your order to be delayed.

  

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