IDesigns Web Services

Account
Sign Up Form
(secured ordering)

Please be sure to read our POLICIES

Please Provide Owner, Administrative,
and Billing Information

ALL fields, except "fax" are REQUIRED unless using a checkbox option!


This Domain will be Registered to:

First Name:
Last Name:
Company:
E-Mail:
Street Address:
City:
State:
Zip or Postal Code:
Country:
Area Code & Phone:
Fax:


The Administrative Contact will be:


You may check this box if ALL ADMIN info is the same as the Domain owner's
OR, If you KNOW the Admin's NIC handle check this box
and enter the NIC handle here (do not guess!)
First Name:
Last Name:
Company:
E-Mail:
Street Address:
City:
State:
Zip or Postal Code:
Country:
Area Code & Phone:
Fax:


The Billing Contact will be:


You may check this box if ALL BILLING Contact info is the same as the Domain owner's
OR, If you KNOW the Billing Contact's NIC handle check this box
and enter the NIC handle here (do not guess!)
First Name:
Last Name:
Company:
E-Mail:
Street Address:
City:
State:
Zip or Postal Code:
Country:
Area Code & Phone:
Fax:

Is This Domain
New or Moved?: 		New Account
Move my Existing Account
Hosting Options:
Domain Name: www.
Designation: .com
.net
.org
.edu

Please note - some cgi scripts will not work with FrontPage installed!


Would you like to have FrontPage Extentions Pre-Installed?


Yes
No

Payment Information


Payment Type:
MasterCard
Visa
Bank Check / Money Order
(Bank checks and money orders require payment of set-up + 3 months in advance)

Credit Card number:
exp:

Who should receive the login info for this account?

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