Domain Name Instructions are in blue text below each field. Required fields are BOLD.
Primary Domain Name:
	The primary domain you wish to host (e.g., "domain.com"). We can currently register domain names with the extensions .com, .net, .org, .info, .biz, .name, .us and country codes (e.g., .ws). We can host domains with any extension.
Redirect Domain Name(s):
	Domains that redirect to the primary domain. Please list multiple redirects in a comma-delimited list with no spaces (e.g., "domain.net,domain.org").
Registration Status:	The domains are NOT registered, please register them. The domains are registered, please transfer them.          Registrar Username/Number          Registrar Password The domains are registered and are pointing to FiberUSA      (Primary NS1.FIBERUSA.COM / Secondary NS2.FIBERUSA.COM
	The current registration status for the domains listed above. If your domain is already registered and needs to be transferred, please enter any username/account number and/or password assigned by the registrar (i.e., Network Solutions, Register.com, etc.)
Hosting Account Please select the type of hosting account you wish to order. You may upgrade or downgrade your account at any time. Plan BlueFIBER Basic BlueFIBER Corporate BlueFIBER Enterprise BlueFIBER e-Commerce $ Setup + DNS FREE FREE FREE FREE $ Monthly US$ 14.95 US$ 29.95 US$ 39.95 US$ 49.95 Space 50 MB 100 MB 200MB 200MB E-mails 5 10 20 20 CGI-BIN No Yes Yes Yes FTP No Yes Yes Yes Monthly transfer 10GB 20GB 30GB 30GB e-commerce (Censtore) no no no included * Additional Hard Drive Space is billed monthly at 25 cents per MB. ** Additional Data Transfer is billed monthly at 1 cent per MB. Hosting Services Please indicate your preferences for FTP, Email and Statistics below. Your ftp, email and statistics may be changed at any time.
FTP Password:
	Enter an FTP Password that you wish to use or leave it blank and a random password will be assigned. The FTP Password is case-sensitive.
POP Email:	Username Password @yourdomain.com @yourdomain.com @yourdomain.com @yourdomain.com @yourdomain.com
	POP emails are stored on our server and are retrieved with a username and password. Enter the desired POP username(s) and password(s). If passwords are left blank, random passwords will be assigned. POP passwords are case-sensitive. Additional POP accounts can be added later.
Forwarding Email:	Username Forwarding Email @yourdomain.com @yourdomain.com @yourdomain.com @yourdomain.com @yourdomain.com
	Forwarding emails (or aliases) are immediately redirected to the specified forwarding email address and are not stored on our server. Enter the username(s) and forwarding address(es). Additional forwarding emails can be added later.
Statistics:	Yes No
	Additional $5 per month. Statistics are a graphic analysis of your web site traffic for the previous month.
Hosting Account Contacts Please enter the administrative, billing contact information below. This information is used to send set-up information, invoices and notices of issues regarding your hosting account. Please choose which contacts receive the initial account set-up information using the checkbox at the bottom of each section.
Admin Contact:
Organization:
Contact Name:	(First) (Last/Surname)
Title:
Address:
City:
State:	(2 Letter Abbreviation)
Postal Code:
Country:	(2 Letter Abbreviation)
Phone:
Alt Phone:
Cell Phone:
Fax:
Email:
Set-Up Email:	Send initial set-up email to the administrative contact.
	The administrative contact is the main contact for the web site. The administrative contact should have the ability to make any decisions regarding the web site and will receive all announcements pertaining to the web site. The administrative contact has ultimate authority to authorize any change to the hosting account.
Billing Contact:	Check if the billing contact is the same as the admin contact.
Organization:
Contact Name:	(First) (Last/Surname)
Title:
Address:
City:
State:	(2 Letter Abbreviation)
Postal Code:
Country:	(2 Letter Abbreviation)
Phone:
Alt Phone:
Cell Phone:
Fax:
Email:
Set-Up Email:	Send initial set-up email to the billing contact.
	The billing contact is responsible for the payment of the hosting account and receives all account statements and invoices. The billing contact may authorize any change in the hosting account.
Hosting Payment Information Please select a payment type and enter your payment information for the hosting account.
Payment Frequency:	Choose One Monthly Quarterly Annual (10% Discount) Annual Auto Renewal (10% Discount)
	The frequency that your hosting charges are debited or invoiced. All Annual payments receive a 10% discount. Select "Auto Renewal" to renew your annual payment automatically.
Credit Card Debit:	Debit the following credit card for all hosting fees.
Credit Card Holder:
Credit Card Type:	Choose One American Express Discover/Novus MasterCard Visa
Credit Card Number:
Expiration Date:	Month 01 Jan 02 Feb 03 Mar 04 Apr 05 May 06 Jun 07 Jul 08 Aug 09 Sep 10 Oct 11 Nov 12 Dec Year 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
	A statement itemizing your hosting charges will be mailed on the 15th of the month prior to the hosting period. Credit card debits are made on or after the 25th of the same month the statement is mailed.
How Were You Referred to FiberUSA? Be sure to enter who referred you so they may receive a $20 Credit on their account.
FiberUSA Affiliate:	(ID, Company Name or Contact)
Word Of Mouth:	(e.g., Friend, Coworker, Relative)
Search Engine:
Other:
Additional Questions or Comments
Comments:
TERMS & CONDITIONS Please Read the Terms and Conditions Here before Sending Order I agree to the above terms and conditions and wish to place my order with FiberUSA.com