Web Site Hosting - Simplex Services Order Page

Web Hosting Registration

I HAVE READ AND AGREE TO ALL POLICIES AND TERMS AND CONDITIONS AS SET FORTH BY SIMPLEX SERVICES FOR THE SERVICES ORDERED: YESNO
New Customer Information Form.
Desired account?
Standard Annually @ $360 Standard Semi-Annually @ $204 Standard Quarterly @ $111	Extended Annually @ $480 Extended Semi-Annually @ $276 Extended Quarterly @ $150
First name?	Last name?

Email address?	Business name?

Please describe your organization (or yourself!).
	Install Frontpage ext. Java Chat $10.00/mo. (Standard) Real Audio/Video $10.00/mo. (Std) MajorDomo $15.00/mo. (Standard) Referrer Logs $5.00/mo. (Standard)
Mailing & Contact Information.
Street address (1)?	Street address (2)?

City?	State?

Zip/postal code?	Country (2 letter Code)?

Phone number?	Fax number (if applicable)?

Domain Name Registration.
Check to see if your desired domain name is already taken by clicking here!
Create a new domain name?	Move domain from previous location?
Yes.	Yes.
Domain name (1st choice)?	Domain name (2nd choice)?

Please note that InterNIC will bill you directly for domain name registration. The current registration rate is $35.00 per year and the first two years must be paid within thirty days of domain activation.
Upon submitting this registration you will be sent to the payment processing center. We accept payment by check online or via fax and, of course, we also accept checks or money orders through postal mail. All payments must be in US FUNDS and drawn upon US banking institutions ONLY. After submitting the initial payment and set-up fee, you will then be billed at the regular intervals your account type requires. Your account will be activated upon receipt of payment. The account will remain open until you cancel it in writing, or it's closed due to non-payment or violation of policies.