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Web Hosting Sign Up Form
Please note that all fields marked with an * are required.
Domain Name*:
Hosting Plan*:
Preferred Username*:
Password*:
Username and Password must each be at least 4 letters/numbers.
If you leave these fields blank, a user/pass will be assigned to you.


Hosting Options
Billing Period*: Monthly Annual (10% Discount)

Frontpage  : Yes     No
(available for Expert Plan and above only)

Dedicated IP  : Yes     No
($2/month more; free for Power Pro Plan)

MySQL Database  : Yes     No
(free to Expert Plan and above)

PostgreSQL Database  : Yes     No
(free to Business Plan and above)


Hosting Contact Information
First Name*:
Last Name*:
Organization  :
Address*:
Address  :
City/Town*:
State/Province*:
Other Province  :
Postal Code*:
Country*:
Email Contact*:
Phone*:
FAX  :
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