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Reseller Information
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Reseller ID #:
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Reseller Org. Name:
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Your Name:
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Your Email:
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Your Phone:
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Your Fax:
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[1.] Domain Name/Action Requested
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Domain Name: www.
I want to:
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[2.] Customer Info (owner of domain name)
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Organization Name:
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Is this a Nonprofit organization? No Yes
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If Yes, enter 501(c)3 number:
501(c)3 number is required for all Nonprofit Organization Accounts
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First Name:
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Last Name:
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Address 1:
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Address 2:
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City:
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State/Province:
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Zip/Postal Code:
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Country:
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Use 2 letter country code
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Phone:
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Fax:
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Email:
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[3.] Hosting Services Requested
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If you are only registering a domain name at this time, leave this section blank.
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Hosting Plan:
Click Here to
Review Hosting Plans
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501(c)3 number is required for all Nonprofit Organization Accounts
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Additional Features:
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FrontPage Extensions (Plus, VIP, NP Plus, NP VIP Only)
Read FrontPage Notice if choosing this option
Streaming RealAudio/Video (Plus, VIP, NP Plus, NP VIP Only)
$5.00/month per stream charge will be added
CGI Discussion Board (Plus, VIP, NP Plus, NP VIP Only)
$20.00 setup fee will be added
MiniVend Shopping Cart (VIP, NP VIP Only)
$120.00 setup fee will be added
MySQL/Postgres Databases (VIP, NP VIP Only)
$120.00 setup fee will be added
Secure (SSL) Server (VIP, NP VIP Only)
$259.00 will be added for Web Server SSL Certificate
Windows Server (VIP, NP VIP Only)
10% Windows surcharge will be added
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Desired User Name:
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Desired Password:
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Retype Password:
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User Name and password must start with letter and be 6-16 characters/all lowercase, and contain numbers/letters only.
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Notes on Email:
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All email addressed to the domain name for this hosting account will be forwarded to the email address provided under Customer Info unless otherwise requested. Depending on the hosting plan chosen, specific email aliases and email boxes may be created with additional forwarding. Please enter these requests in the Special Instructions Box below.
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[4.] Internet Access Special
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If you are only registering a domain name at this time, leave this section blank.
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New Hosting accounts are eligible for Dialup Internet Access at a special low price of only $12.00/month or $120.00/year with FREE setup!
This is a 56k (V.90) modem dialup account and we have over 1,200 local dial-up numbers covering all 50 US states, plus all 10 Canadian provinces.
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Click Here to
Check for a local
dialup number
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Yes! I want to add Dialup Internet Access to my hosting account:
$12.00 per month
OR
$120.00 for one year
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Desired User Name:
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Desired Password:
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Retype Password:
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User Name and password must start with letter and be 4-16 characters/all lowercase, and contain numbers/letters only.
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[5.] Submit Order
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Response Method:
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Send Email Please Call Send Fax
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Special Instructions:
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Please Note:
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All orders require prepayment and are charged to the credit card on file with InfoTeam. The total amount charged is based on the services ordered and the amount of your reseller discount, and will be sent with your order confirmation.
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I Agree to the terms and conditions of all of the following:
Domain Registration orders are NON-REFUNDABLE.
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Questions? Call 1.877.819.0414
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