Pharamond - Web Hosting

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Web Hosting Order Form:

I. Client Information
Name (first, last):	,
Company Name:
Address:
City, State:	,
Zip Code:
Country:
State (if other than the United States or Canada):
Phone Number:
Fax:	(Optional)
E-mail:
Additional E-mail:
User Name:	The user name must start with alpha characters and consist of alpha characters, numeric characters, the minus sign '-' or underline '_'. Alpha characters must be in lower case. The length of User Name should be no more than 8 characters.

II. Account Status: New or Transfer Domain?
Payment for new domains must be made before the domain can be registered.

New Domain Registration ($20US per Year)
Transfer existing domain
I Prefer to handle domain registration and or transferring myself.

III. Your Virtual Domain Name

Virtual Domain Name:	http://www.
If this is a new domain, please check the availability of the domain here.
Use the information above for the Administrative Contact information.
Use the information above for the Billing Contact information.
Have us be your Technical Contact.

IV. Hosting Package (Prices in US Funds)

Visa, & MasterCard are accepted here!

Hosting Package:

Payment:

Payment Type: Check or Money Order Visa / MasterCard

If you would like to pay by Credit Card, please input your Credit Card information on our secure form at https://pharamond.net/payment.html after you place your order.

I agree to the Terms of the Usage Policies

Comments:

Your account should be activated within 10 minutes. You will be e-mailed a complete "Welcome Letter" containing the URL to your Online Control Panel, your username, FTP hostname and IP address. You will then be able to administrate and begin uploading your files to your new web site immediately. You will be able to use your IP address (sent to you in your activation notice) to access your website.