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DomainMaker One Step Order Form
Domain Name Registration included with paid hosting service.
Incomplete forms will not be processed
Domain Registration: New Domain Transfer Existing Domain
Update my account Renew Domain Name
Domain Name:
Plan Length, Renew or Update Information:
Please enter the password required for your login
here:
Microsoft
FrontPage Extensions ($no additional charge) NoYes
Real Audio/Video server support ($20 setup + $5/month additional) NoYes
Virtual Control Panel (only $20 setup)
NoYes
Special Instructions:
First
Name: Last Name:
Company Name:
Address:
City:
State/Province: Zip/Postal Code:
Country:
Phone: Fax:
How did you
hear about us?
Are you interested in
becoming a reseller?
PAYMENT INFORMATION
IMPORTANT:
Contact and Billing Address for credit cards are
handled separately.
Even if both are the same, all address fields
for contact and billing MUST be filled
Type of payment: Visa Mastercard
Card Number: (numbers only -
please no dashes or spaces)
Expiration
date: (MMYY)
Name On
Card:
Billing address as on card:
Home Phone: Business Phone: Fax Number:
AGREEMENT TO TERMS
By typing your name in the
"Electronic Signature" below, and pressing the "Submit Order" button below, you
hereby agree to the Terms and Conditions. You also agree to abide by
DomainMaker's policy statement and hereby authorize all expenses associated with
this account. Additionally, any monthly, quarterly, semi-annual or annual
charges are authorized to be billed, when due, to this account.
Electronic Signature (required):
Email address to
send setup instructions (required):
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