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netbasiks.com Order Form

 

Order Online : Hosting

This application is secure and 128 bit encrypted for your protection. You will receive your initial IP address, username, password, and quick start packet via email within TEN minutes of submission.

We accept Visa, MasterCard and American Express.

 
   Domain Information
Enter the Domain Name here: www.

(remember to include the TLD such as .com, .net, .org, .co.uk etc.)

SELECT ONE:

I already own my Domain Name and will handle my registration or transfer.

Register New Domain Name through netbasiks.com (The Fee is $20 per year.)

Number of years your domain name will be registered for:

Provide Domain Name Owner Information (for New Domains ONLY)
Only change this section if you would like to fill in specific contact information for NEW domain name registration.
If you uncheck any of these boxes, you will be prompted for the contact information on the next screen.
Use my information for the Administrative Contact information.
Use my information as listed below for the Billing Contact information.
Have us be your Technical Contact.


User Name: (4 to 8 characters)
The user name must start with a letter and can consist of letters and numbers. All characters must be in lower case.
Account Package:
 
Billing Cycle:
   Contact Information
Name (First, Last):
Company:
Below, please enter your credit card billing address, using numbers instead of words. For example, enter "123 Fifth Ave." as "123 5th Ave.".
Address:
City, State, Zip:
State (if other than US or Canada):
Country:

Phone Number:
Fax: (optional)
Current E-Mail Address:
Please enter an additional e-mail address below. This address should not include your new domain name, providing us with an alternative way to contact you via e-mail. If you do not have a secondary email, please enter your current email address from above.
E-Mail Address 2:

Comments/How Did You Find Out About Us: 

   Billing Information

PAY BY CREDIT CARD
Card Type:
Name on Card: e.g., John A. Smith, Jr.
Card Number: e.g., 4123-4567-8910-1234
Expiration Date: /

For security purposes, we have recorded your IP address (54.81.158.195). We take Credit Card fraud very seriously, and will prosecute to the fullest extent of the law.

PAY BY CHECK
If you would like to pay by check, please indicate on the check your domain name and account package. Make check payable to netbasiks.com

Mail check to:
netbasiks.com
ATTN: New Accounts Setup
P.O. Box 46021
Minneapolis, MN-55446-6021
USA

Your account will be set up within 24 hours of bank clearance of your check.

Note: If you are signing up for  the "Reseller" Package, please use a Credit Card as means of Payment.

   Terms of Service

By clicking on "Review Order" below, you certify that you have read and agree to comply with the netbasiks.com's Terms of Services (TOS).


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