Order Shared Basic Virtual Website for $.99/mo + $10 setup fee

This order form will be SSL encrypted and transmitted securely when you click on the " Order Now!" at the bottom of the page.

Step 1 - Choose upgrade options...

Upgrades	Options		Totals
Add Customized WebPages:
Additional Web space:			MB
Additional bandwidth:			MB
Additional email accounts:
Additional email aliases:
Additional email auto responders:
Additional email groups:
Majordomo Mailing List:
Enter your mailing list name:	@w3hosts.net
Additional FTP accounts
Add technical support:
Domain name:
Enter your domain name:	www. .
Enter PROMO discount code:
Add Dial-up access: (Unlimited and ISDN not available in all areas)	I already have Internet access 150 hrs/mo 56K modem access for $18.95/mo Unlimited 56K modem access for $21.95/mo 150 hrs/mo single ISDN access for $34.95/mo 150 hrs/mo dual ISDN access for $39.95/mo Unlimited dual ISDN access for $200/mo Static IP single ISDN access for $200/mo		View Phone Numbers
Subtotals:	Monthly	Setup fee	FREE FrontPage Extensions

Step 2 - Enter your personal information...

Enter your login name:
Enter your password:	Confirm password:
First name:
Last name:
Address:
City:
State:	Zip code...
Phone number:
Current email address:
Confirm email address:

Step 3 - Enter your payment information and sign the agreement...

Payment Method:
Credit Card number:
Credit card expiration date:	/
Name as printed on card:

Credit card address if different from personal information address...

Address:
City:
State:		Zip code:

Please type your full name in the box below. By doing so you agree to the following paragraphs:

I agree that I have read, understand and agree to the terms, conditions and acceptable use policy. I am requesting services and/or products from W3Hosts as indicated on this form. I agree to pay all charges billed by W3Hosts as indicated on this form and outlined in the terms, conditions and acceptable use policy associated with the provisions of requested service and/or products.

To the best of my knowledge all information I provided on this form is true and correct. I agree to provide W3Hosts corrections and/or changes should any of this information be submitted in error or any information I have provided changes at any time during the term of this agreement.

Enter your legal name:	Sign as electronic signature. for example: /John Q. Public/
Date:

You will receive a confirmation email within a few minutes of submitting this form. Another email will follow with your personal IP address and additional account information. If you do not receive a confirmation email within 2 hours please contact W3Hosts at W3Hosts Accounts Department.