Danjo Creations Targetted Hosting Order Form

General Client Info

 
Your full legal name:
Billing Name:

first last

  Specify the billing address in comments section
if it differs from the following
Company:
Address:
 
City:
Province/State, Postal/zip:
State if outside US/Canada:
Country:
Preferred Email:
 
Must be a valid email address, and it can be an address under
this domain that is being hosted - used for normal correspondance
from us about your hosting account. If you are registering a new
domain name, this will be used for renewals and other registry
correspondance and appear in the public WHOIS for the domain name
unless you request otherwise in the comments area below.
 
Contact info in case of a problem
 
Backup email address:
 
YOUR INITIAL SIGNUP INFORMATION WILL BE SENT HERE
Should be a current valid email address provided by your ISP
For our use only, this will NOT appear anywhere publicly.
We use this as emergency backup only for critical matters
in case we can't reach you at your preferred email address.
 

phone: ext       fax: ext

Include country code (where applicable) and area code
 
Account Configuration
 
Desired User Name: 4-20 letters&numbers, lowercase, allowed hyphen & underscore 
Domain Name
to be parked		 (Read guidelines)
Include the extension (i.e. whatever.net)
View domain prices
Check availability

Register this new domain for me in my name for year(s)
This is my existing domain name -
I prefer to handle my own domain registration and renewal
 
Plan, Payment, and Discounts
 

If you have a coupon code, enter it here:

Choose plan: click to Convert this Amount into your Currency $30 | $20

Visa   MasterCard   PayPal   Money Order   Check
Name on Card
Card Number & Expiry (mm/yy)
 
Other
Comments:
How did you
hear about us?
 

(required) I agree to all terms and conditions
presented herein for the services I am requesting
Hosting Policies, Guidelines, and Disclaimer
Domain Registry Agreements and Dispute Policies

Yes, I want to be included in member listings
Danjo Creations may post my site name, screenshot, and hyperlink
in places such as a member directory or featured site listing, etc...
Danjo Creations must ask my permission before using any other info.


Your total will be calculated and presented
for your confirmation on the next screen