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STEP TWO
Hosting Package
Domain Name www.
(Do not include or prefix with "www.")
Username (Maximum of 8 alphanumeric characters)
Password (10-18 alphanumeric and special characters)
Organization Name (optional)
Name (First)
Name (Middle Initial) (optional)
Name (Last)
Postal Address Line 1
Postal Address Line 2
City / Town
State / Province
ZIP / Postal Code
Country
E-mail Address (If you only have one address ...)
Alternate E-mail (...then enter the same for both.)
PayPal E-mail
Tel. Country Code
Area Code & Tel. #
Fax Country Code (optional)
Area Code & Fax # (optional)
 
Instant Messenger Contact Information
This information is optional, but will help us to provide more in-depth and interactive technical support.
It may also be used to assist in verifying your account ownership if you contact Support over IM.
AIM (optional) (AOL Instant Messenger)
Google Talk (optional) (Google Talk, Instant Messenger)
ICQ (optional) (ICQ, Instant Messenger)
Jabber (optional) (Jabber, Instant Messenger)
MySpaceIM (optional) (MySpaceIM, Instant Messenger)
Skype (optional) (Skype, Instant Messenger)
Twitter (optional) (Twitter, Instant Messenger)
WLM/MSN (optional) (Windows Live (MSN) Messenger)
Xfire (optional) (Xfire, Instant Messenger)
Yahoo (optional) (Yahoo! Messenger)
 
Notes
You may wish to include additional notes to help specify preferred customizations or other requests.
(i.e. someone referred you, or you need account data transferred from a previous service provider or host)
 
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Your IP Address
Your Host Name
Your User-Agent
HTTP Referrer
Request URI
Order Time Stamp
 
 
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