Content

apply

We handle each hosting request personally to ensure the best service possible. Please complete this form and you will be contacted shortly to get set up.

Contact Information

Please enter the contact information for the main developer or administrator of this site
Company or Organization Name:
First Name:
Last Name:
Address:
City:
State:   Zip:
Email:
Phone:
Fax:
How would you prefer to be contacted?

Billing Information
How frequently should we send invoices?
How would you prefer to receive your invoices?
How would you prefer to pay your bill?
If paying by credit card, please enter the information here. Your card will not be charged until the first billing cycle after your account is up and running.
Card Type:
Name On Card:
Card Number:
Card Expiration Date: Month: Year:

If your billing contact information is different from your administrative contact information, please enter it here:
Company or Organization Name:
First Name:
Last Name:
Address:
City:
State:   Zip:
Email:
Phone:
Fax:

Your Site

Which hosting package would you like to use?
basic
connect
interact
exchange

Additional options
The $10 setup fee for additional features is waived when you add them with a new account.

subdomains ($2/month) additional database ($12/month)
announcement list ($5/500 recipients/month) discussion list ($5/50 recipients/month)
extended log analysis ($10/month) SSL Certificate $100 per year
additional domains sharing these resources ($5/month) domain name aliases for this site

Is this a transfer of an existing site or an entirely new site?
Transfer New Site
For a New Site:
Have you registered a domain name already? Yes No
Whether you've registered it or not, what domain name would you like to use?
 
For an Existing Site:
What is the URL of your present site?
Who is your current hosting provider?
 
Additional questions or instructions:

Web and email hosting with merchant services, PHP support and a flexible reseller program