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Secure Order Form

This form is for new clients only.

Existing clients should order via the client zone for a shorter form.

Please read our policies before ordering.
Submitting this form indicates your agreement to these policies.

What Kind of Site Do You Want?
(Options below may affect your cost)
Full Featured Site
      (3000 MB space, 500 GB traffic)   
 Full e-commerce $29/month
Lite Site
      (2500 MB space, 300 GB traffic)
 Budget e-commerce    $19/month
Mini Site
      (2000 MB space, 250 GB traffic)
 Basic features $17/month
Micro Site
      (1000 MB space, 200 GB traffic)
 Budget features $9/month

Is this a New or Transferred Domain?
If this is a new domain, you must register it somewhere such as NameCheap, we no longer register domain names.
Provide these DNS Servers when you register it: cp.host4u.net and cp2.host4u.net
Transferred Domain        
      (abc.com)		 No registration fee            $0 setup fee

What is the Domain Name?
If you wish to setup more than one domain name, request parked domain(s) after ordering.
Please do not enter more than one domain name here.
Domain Name:

Contact Information
This information will be used if we need to contact you regarding this site.

First Name:

Last Name:

Email:
Business or Site Name:     
Address:
City:
State or Province (if any):
Zip or Postal Code:
Country
Telephone:

Options (you can easily change options later)
Microsoft Front Page interface - FREE
Display Our Banner - $5/month off ($1/month off for "Micro" sites)
Prepay for one year - SAVE 10%
      (your site will automatically renew annually at the discounted rate)

Any Promotion Code or Special Instructions?
Click here if you want to validate a promotion code prior to ordering.
Promotion Code:
If you have any special instructions, enter them here. If you desire optional features, use an add-on form after ordering your site to add Miva Merchant, parked domains, etc. Entering unnecessary comments here will delay processing of your order.

Payment

Select your payment preference. Your account will be billed monthly unless you elect to pay annually (saving 10%).
Visa    MasterCard    Discover    American Express
Credit card number:
Expiration: Month: Year:
Card Identification Number:     Where is this?
Cardholder Name:
Street Address:
City, State/Province, Country:
Zip/Postal Code:
Issuing Bank:
Customer Service Phone Number (back of card):
Will mail check or money order (must be in U.S. dollars, and either drawn on a U.S. bank or a postal money order - our address). Note: we must receive payment before this order will be filled.
Bill to reseller account
Reseller email address:

Referral
Please enter the website name if someone referred you here.
Verification code image
Enter the verification code from the picture above.
The code consists of uppercase letters and digits.

If you're considering fraud, we track your IP address - 18.222.163.31- when this order is placed.
We verify all billing information before filling orders and forward fraudulent orders to the authorities.

It may take a minute or two to process your order, please be patient and hit Submit Order only once.