If you prefer you can fill out this page, print it and mail or fax it to us.  We will contact you concerning the payment process.

Account Information
Absolutely No Adult, Warez or MP3 Sites
Password:
Verify Password:

Domain Information
Please check first to see if the domain name you want is available, and then fill in domain name (i.e. yourname.com, yourname.net, etc.)

Domain Name: www. 
Is it a Transfer? No. it is a new domain
Yes, please transfer my domain

There will be a fee for new domain registration with InterNIC.  Domain transfers and new registrations are $20.00.

Account Add-On

FrontPageŽ 2002 Extensions:

(free!)

Note that all prices are in US Dollars.

New Domain Registration Information (Optional)

Registrant/Organization Information:

Organization Name:
Organization Address:
City, State, Zip


Administrative Contact:
Use my assigned NIC handle
Use below information

Name:
Type of Contact: Individual Role Account
Organization:
Street Address:
City, State, Zip
Phone:
Fax:
E-Mail:


Billing Contact:
Use assigned NIC handle
Use administrative contact information
Use below information

Name:
Type of Contact: Individual Role Account
Organization:
Street Address:
City, State, Zip:
Phone:
Fax:
E-Mail:
  

By typing your name above, and pressing the "Create Account" button below, you hereby agree to the Terms and Conditions and hereby authorize all expenses associated with this account.

Notice:  If you mail or fax this application, you must sign it before submitting it.

Print Name: ____________________ Signature: _____________________

 

 

Note:  After pressing "Create Account" you will be directed to the selection page to select the hosting/service you desire.