BonusPages - Low Cost Web Hosting Service

Virtual Domain Order Form:

Instructions: Please follow this step-by-step form in its entirety. Use this form to register for your own Virtual Domain web site. When you've completed the form click on "Send Order" and we'll begin processing your request.

E-mail Address Verification: You should receive an order verification request at the E-mail address you specify. No action will be taken on your order until you reply to this message so to avoid delays in processing please reply promptly. We'll keep you updated by E-mail as your order is processed.
Note: InterNIC charges are not included. An additional fee will apply to register and maintain your domain name in the OpenSRS DNS database. This applies in the case of new domain name registrations - not transfers.
Please fill out the form below COMPETELY to avoid processing delays.
First Name:
 Last Name:
Company/Organization Name:
Street Address:
City:
 State/Province:
Zip/Postal Code:
 Country:
Phone Number with Area Code:
 Fax Number.(not required):
E-mail address:
 Purpose of Domain: (must choose 1)

ENTER YOUR DOMAIN NAME SELECTION
Enter your first choice .....................
Enter your second choice.(optional)...
Registration Instructions;
Register my:

ENTER YOUR WEB SITE ORDER SELECTION
Process my order for:


TERMS AND BILLING


I agree to pay $35.00 US setup fee to MediaSuites Enterprises for each Domain ordered. I also agree to pay my full web site rent fees in advance prior to the end of each billing cycle. I understand that access to server facilities for any account in arrears will be suspended pending receipt of any payments due. Your payment MUST be received before the registration for your site can be completed. Send your check or money order to:
Payable to:


 		MediaSuites Enterprises
594 Sawdust - PMB #146
The Woodlands, TX 77380
This service is strictly for Domain hosting and may not be resold. I understand that an OpenSRS Domain Registry fee ($19.95 US for .com, .net & .org) per year will apply to register and maintain my domain name in their DNS database (new domains only). Payment of this fee is required prior to completing the registry process and will be billed along with my hosting fees. I agree to be bound by the TLD domain name registration agreement and ICANN Uniform Domain Name Dispute Resolution Policy as applicable.

Accepted (type your initials here)

  
Copyright © 1997-2004 MediaSuites Enterprises • 594 Sawdust - PMB #146 • The Woodlands, TX 77380