HOSTING ORDER FORM
This form is for hosting ordering only!
 If you would like a website built and  hosted, please click here for a free quote.
Domain Name Registrants Benefits and Responsibilities

Required Information

Your Name:

Business name you want to register your domain name under.

Address

City:

State you live in:
Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgia HawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichigan MinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyomingOutside US

Your Zip Code:

Telephone Number:

Fax Number:

Your E-mail Address? Please Double Check It. Need it to get back with you! :-)
(e.g.: you@aol.com)

Do you have a Domain name now?
 Yes or No

If So, What is your Domain name?

Would You Like Us To Transfer the Domain name?
 Yes or No

If you need a Domain name, what name would you like us to register for you?

Which size hosting plan would you like to purchase?

Please select oneValue Plan 500 mbPro Plan 900 mbMega Plan 1500 mb

Have you read our Acceptable Usage Policies?
 Yes No

Do you have any other comments?

 How did you find us? What Search Words? (Very Important To Us!)

Did you provide a correct E-Mail address above?

To combat SPAM please check this box in order to send: 

 
To send to Blais Web Creations,
Thanks for your time!