By completing and submitting the form below you accept and agree to adhere to Domain Web Hosting Policies, Guidelines and Disclaimer. Click here to view our Policies, Guidelines, and Disclaimer.

WARNING: We do not tolerate fraudulent orders. During the ordering process we track both your user agent (ISP) and IP address. In the event that you submit a fraudulent order, i.e. provide an unauthorized credit card, or present a check against an unauthorized account or an account with insuffient funds, we will file charges with the proper governmental agency. Your user agent is your finger print and can only be used by your computer on the world wide web and IS sufficient proof to law enforcement agencies of your activity on our servers.

(All fields with an asterisk* are required)

First Name:
Last Name:
E-Mail Address:	NOTE: This MUST be the email address that was used to register the domain name if you are requesting Domain Web Hosting to handle the transfer of an existing domain name.
Address 1:
Address 2:
City:
State:
ZIP Code:
Country:
Phone #:

Enter Desired Domain Name:	Examples: yourdomain.com or yourdomain.domainwebspace.com if a subdomain Click here to check the availability of a domain name.
Enter Desired Username:	NOTE: This must be 6 to 8 characters long. Usernames can not be changed once the account has been established.
Enter Desired Password:	NOTE: This must be 6 to 8 characters long. Passwords can be changed once the account has been established.
Domain Name Status:	This is a new domain name, please register it for me. Existing domain name, please transfer it to your server. I will do the transfer myself New domain name, I am handling the registration. This is a subdomain, does not require registration. NOTE: We only register .com, .net and .org names
Your Registrar:	NOTE: Due to registrar requirements, we can no longer make the name server modifications to clients domain registration records. Registrars require the registrant to log into their accounts to manage their domain registration and as a competitor, we can not log into these areas. Your registrar should have clear instructions for modifying the Primary and Secondary Name Server information for your domain name.
Registration Period:	No Registration 1 Year $20.00 - .com, .net, or .org 2 Years $40.00 - .com, .net, or .org 1 Year $70.00 - .cc 2 Years $140.00 - .cc 1 Year $125.00 - .la 2 Years $250.00 - .la 2 Years $48.00 - .info 2 Years $48.00 - .biz 2 Years $50.00 - .us
Choose Your Account Option:	25MB $7.95 mo. 100MB - $9.95 mo. 200MB - $14.95 mo. 300MB - $18.95 mo. 500MB - $21.95 mo. 1GB - $34.95 mo. 2GB - $44.95 mo.
Total Amount To Charge To My Credit Card:	NOTE: This is the total amount you are authorizing us to charge to your credit card for this transaction.

Credit Card Type:	Visa Mastercard Discover
Credit Card Number:
Expiration Date:
Name On Credit Card:
Billing Address 1:
Billing Address 2:
City:
State:
ZIP Code:
Country:
Card Holders Phone #:	(Include Area Code)
Card Holders Email Address:

Additional Comments:


Please review this form before submitting. Once your credit card is approved for the above charges, you will receive an email that will contain your account information. NOTE: The billing name that will appear on your statement will be J & J Enterprises. For security purposes, your remote address and user agent are traced through submission.

BY SUBMITTING THIS FORM YOU AGREE THAT YOU HAVE READ IN FULL AND AGREE TO ABIDE BY DOMAIN WEB HOSTING'S POLICIES, GUIDELINES, AND DISCLAIMERS.

BY SUBMITTING THIS FORM YOU ARE AUTHORIZING DOMAIN WEB SPACE TO CHARGE YOUR CREDIT CARD FOR THE ABOVE AMOUNT TODAY AND ON THIS DAY EACH MONTH HEREAFTER UNTIL YOU CANCEL THIS ACCOUNT. Note: Your domain name registration/transfer authorization is used as additional verification of your account activation on our servers.