netbasiks.com Order Form

Order Online : Alternate Hosting Form

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 one business day. 

We accept Visa, MasterCard and American Express.

   Domain Information

Enter the Domain Name here: www. 

(remember to select the appropriate TLD such as .com, .net or .org)

SELECT ONE:

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

Register New Domain Name through NetBasics. (The Fee is $20 per year and MAY be billed separately to your credit card.)

Number of years your domain name will be registered for:

 User Name: (4-8 characters)

Account Package:

Billing Cycle:

   Contact Information
Name (First, Last):
Company: Enter N/A if none.
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:
Country:
Phone Number:
Fax: (optional)
E-Mail Address:
(please make sure that the email address is accurate)
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:

How did you learn about NetBasics?:

   Billing Information
CREDIT CARD
Card Type:
Name on Card: e.g., John A. Smith, Jr.
Card Number: e.g., 4123-4567-8910-1234
Expiration Date: / (MM/YYYY)
CVV Code:

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   Terms of Service

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


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