ADMCITY online application form

If you are a reseller, use reseller order form.- Web hosting home- How to Pay

Is this request for:

virtual account new domain registration? Enter desired name:

OR

virtual account transfer existing domain? Fill-in domain name:

OR

non-virtual account? Fill-in your chosen username:

Choose the account you want to order

Product Name	3 months	6 months	12 months
Full Virtual Account, 100MB, http://www.username.com or http://www.username.co.uk
Super Deluxe Virtual Account, 200MB, http://www.username.com or http://www.username.co.uk
Hyper Deluxe Virtual Account, 300MB, http://www.username.com or http://www.username.co.uk

Referred by:

E-Mail Address:

PASSWORD:

Name:

Business Name:

Street Address:

City, State, Zip:

Business Phone:

The following features apply to virtual accounts only

Do you need MS FrontPage setup? (free)

Do you need RealAudio? (£9.5/mo)

Do you need Real Audio/Real Video? (£19.5/mo)

Do you need Java Chat? (£7.50/mo)

Additional Notes:

Notes

Handling charge £20 for applying new domains or transferring domains.
New domains will be billed £80+VAT - directly by NOMINET UK
for Domain Name : http://www.username.co.uk
or New domains will be billed £45+VAT - directly by NomiNation UK
for Domain Name: http://www.username.uk.com
or New domains will be billed $70 - directly by InterNic.
for Domian Name:http://www.username.com
One-time setup fee and hosting fees are payable in advance. Optional add-ons (i.e., Real Audio) have additional fees.

Service requests are processed upon receipt and a userid and password will be issued to initiate immediate service. Although you may cancel your service at any time, you remain responsible for any monies due and payable at the time of cancellation. Upon submission of this request order, you will be billed for setup and hosting fees.

Please acknowledge your understanding of these terms with a check here:

Thank You!

We accept credit cards, money order or check.

We do not set up any new account without prior receipt of payment.

You may pay by check or

Visa / MasterCard / AMEX Credit Cards accepted...