*First Name

*Last Name

*Email

*Company

*Address

*City

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*Country

*Postal Code

*Telephone

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*Domain Name

Dot.Inc Solutions can register your domain for $28.95/year. If you choose "no" it is your responsibility to register your domain with another domain registrar and your web hosting account will not be fully functional until you do. Do you want us to take care of your domain registration?

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*Is this a transfer or a new domain registration?

Transfer
New Domain

If this is a transfer, please give the name of your current host.

If you are transferring from another web hosting company, please list the reason why you are switching to us:

If this is a new domain, how many years do you want to register the domain name?
Select One 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years

You may enter your own password or leave this box blank if you want us to randomly generate your password (cAsE sEnSiTiVe):

How did you hear about Dot.Inc Solutions?

*Please select your hosting package:
Level 1 Level 2 Level 3 Level 4 Level 5

Additions:

Real Audio/Video with G2 Capability ($10 per month for Basics account only)
Microsoft^® FrontPage^® Extensions (FREE)
Graphical Referrer Logs ($5 per month)

*Preferred Billing Method:
Select One ------------------------- Credit Card Check

* Billing Cycle:
Quarterly (3 months prepaid)
Yearly (12 months prepaid)

Please type your full name AND email address in the box below. By doing so and submitting this form to Dot.Inc Solutions, you are agreeing to the terms, conditions and acceptable use policy previously set forth by Dot.Inc Solutions. This is a binding document. By placing this order you are requesting service from Dot.Inc Solutions, and therefore do incur all fees associated with the provisions of said service.

I AGREE to all items in the terms, conditions and acceptable use policy:



This document will not be "signed" in the sense of a traditional paper document. To verify the contents of this form, the signatory must enter any combination of alpha/numeric characters that has been specifically adopted to serve the function of the signature, preceded and followed by the forward slash (/) symbol. Acceptable "signatures" could include: /john doe/; /jd/; and /123-4567/. For example: if your name is John Miller, you could type /John Miller/ below.
  

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