Real-WebHosting.Net Order Form

Domain Name Information

You may request the domain name of your choice. Domain registrations are not refundable. Domain names can consist of lower-case alphanumeric characters, and the hyphen (-). Domain names must end in .com, .net, .info, .us or .org.

Enter the domain name you wish to use for your site:

Select One
New Domain Registration
Real-WebHosting.Net has permission to transfer this domain from the current registrar and/or hosting company.
Client will take care of the domain registration or transfers from the current registrar.

Hosting Information

Please choose the hosting package, contract length and User ID that is right for you. Remember,only annual contracts save $5.00 per month.

Pricing Info:
Level I (EZ-1) $12.95 per month paid annually
Level II (EZ-2) $24.95 per month paid annually
Level III (EZ-3) $34.95 per month paid annually

Hosting Package

Subscription Length:

Contact Information

Choose a User ID in lower case letters.		Company (optional)
Current Email Address:		Secondary Email Address:
First Name:		Last Name:
Street Address:
City:
US/CANADA State/Province:		Postal Code:
State if not include at above:		Country:
Phone Number:		Fax (optional):
Billing Info
Name on Credit Card:		Type of Card:
Credit Card Number(no spaces):		Last 3 digits on backof card. 4 digits on Amex cards)
Expiration Date:
Payment by Credit Card with information above or I wish to pay by check and understand that Real-WebHosting.Net will not process my order until payment is received
Comments (optional):
Submit Your Order:
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