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NOTE: Your IP Address and Remote Host Information is being stored when this form is submitted. This is to help fight fraud on the Internet.
IP Address: 52.91.176.251 Primary Name Server:
NS.MY-EHOST.COM
Your account will be setup
the same day. We have no setup fees. You will be charged once your account is setup and
on the same day each month afterwards for hosting fees in the amount of $24.95.
If it is - Fill Out The
Form Below So We Can Get You Set Up
Note:
We Will Register Your New Domain Name For You - $15 For One Year. If Your Domain Is Already Registered See The Bottom Of This Form. We Have
No Setup Fees. Billing Will Start The Day You Are Setup And Will Be Billed That Same Day Each Month After
- $24.95 Per Month.
Host4Profit.com
Order Form
Protected by The Safest
Encryption Techniques
Order Code:
102023
Enter the FULL domain name below, including extension (.com, .net, .org or other valid extension). The http://www. part of the domain name is not needed.
Your Domain Name:
http://www.
Register Domain Name:
*Please let us know if this
domain is a new one or
will be transferred over
to us. The $15.00 domain name registration fee is non-refundable and is good for a year.
First Name:
Last Name:
Company Name:
Address:
City:
State:
State (if not listed above):
Zip/Postal Code:
Country:
Email Address:
*Avoid using free email addresses
Phone Number:
Fax Number:
Select Credit Card:
Cardholder's Name:
Credit Card#:
Expiration Date:
MM/YY (2 digit month/year)
Card Code (CVV2):
(3 or 4 digit code on back of card)
Billing Address:
Billing Zip Code:
I Agree To The Terms Of Service. Click Here For Full Details.
I Agree Not Send Spam Via Host4Profit's Servers Or Using A Domain Name Hosted On Host4Profit's Servers. Click Here For Full Details.
I Agree Not To Join "Safe To Email Lists". Example Lists Run By Companies Such As Egroups, eLists and GlobeLists. (Because Of The Thousands Of Emails That These Lists Bring In, They Consume Too Many Server Resources And Are Rarely Read By The Recepient, We Must Enforce This Restriction)
I Agree That My Credit Card Will Be Charged $24.95 On Setup And On That Same Day Each Month After By HASBROUCK ENTERPRISES, INC / HOST4PROFIT.COM.
Existing Domain To Transfer To Our Servers
: If this is a domain you already own and will
be transferring to our servers you will need to contact
whoever you registered your domain name with and put our Name
Server information as stated below:
Primary IP Address:
198.31.50.20
Secondary Name Server:
NS2.MY-EHOST.COM
Secondary IP Address:
65.98.25.54
