On-Line Web Order Form

Domain Registration Form
Registration Type New Domain
Transfer Existing Domain
Domain Name
Check Domain Availability
Domain Registrations 1 year $25
2 years $50
3 years $75
5 years $100
10 years $200
Website Design
Please contact me about designing my website
I do not need design services
Account Information
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Last Name
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E-Mail Address
Address
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Zip / Postal Code
Country
Phone
Fax
interested in our other services? (check all that apply)
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(if different than above)
By completing this form, I confirm that I understand the rates and fees related to the account.
(You must check here to proceed.)

Thank you for choosing Internet Host Services. We are truly the last web host you will ever need.

Please fill out this form completely. Once your order has been received, we will contact you to verify that we have received your information. At that time, you can request that we download and set up your website. We will also mail you an invoice for your records.

Your domain will be set-up on our servers in approximately 24-48 hours and account access information will be e-mailed to you upon completion.

Please read these Terms & Conditions before continuing. We don't accept adult sites and no spamming allowed. If your browser doesn't support the form below, please call (800) 730-6761 and we can fax you a copy.

Thank you very much for your business.