DomainsNow.com - Domain Name Registration Application

Welcome to DomainsNow

sales@domainsnow.com
1-800-393-2181
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Domain Name to be Registered (Do not include the "www" part, 22 characters max.)
Organization or Business Name
Type of Business or Use of Domain Name (Only a brief description is required)
ADMINISTRATIVE CONTACT
Name
Street Address
City
State/Province
Zip/Postal code
Country (2 letter code)
(required by the InterNIC) Phone Number
FAX Number
(required by the InterNIC) E-mail Address
BILLING CONTACT If billing contact is the same as the administrative contact you may leave this section blank
Name
Street Address
City
State/Province
Zip/Postal_Code
Country (2 letter code)
Phone Number
FAX Number
E-mail Address

OPTIONAL SERVICES FOR YOUR NEW DOMAIN NAME
If you are not interested in setting up a hosting account, email, or domain re-routing,
you may skip these sections.

HOSTING ACCOUNTS

We have two different hosting plans to choose from. For more detailed information on our hosting plans, please see our hosting page. You are under no obligation to setup a hosting account at this time. If you only want to register a domain name we will point it to our under construction page.

Account	Set-Up Fee	Monthly Fee	Description
Small Business Hosting Plan	$30.00	$29.95	2 E-mail boxes 30 megs storage space 1 Gig of data transfer
Corporate Hosting Plan	$30.00	$49.95	10 E-mail boxes 50 megs storage space 2 Gig of data transfer

If you would like us to setup a hosting account for your domain name, please choose an account and enter a 2 to 8 character username and password. After your domain name has been registered successfully, you will receive instructions by email on how to upload pages to your account.
Small Business Hosting Plan Corporate Hosting Plan
UserName: (2 to 8 characters, letters or numbers, all lower case, start with a letter)	Password: (2 to 8 characters, letters or numbers, upper or lower case)
E-Mail Options Forward all e-mail addressed to @mydomain.com to this e-mail address: Store my e-mail on your server (POP3 "catch all") All e-mail addressed to anyname@yourdomain.com will go to this one mailbox. (Please note: you will have to log in with your e-mail program to get your mail. This will require changing settings on your e-mail program.) You will use the same username and password as your hosting account to get your mail. I would like to setup individual POP3 e-mail boxes (Please note: you will have to log in with your e-mail program to get your mail. This will require changing settings on your e-mail program.) For each e-mail box please specify the name for the e-mail box, and a 2 to 8 character username and password in the comments section below. (For example: you@yourdomain.com, username, password) If you would like any of these individual e-mail boxes forwarded to another address, you only need to specify the name of the e-mail box, and where it should be forwarded.
Check here if you need FrontPage extensions added to your account Check here if you need secure server access. (Available as an option with the corporate plan only, one time $20 setup fee)

FREE EMAIL FORWARDING
Please skip this section if you are getting a hosting account
Hosting accounts come with e-mail

For our customers that do not need a hosting account at this time, but would like to receive email at their new domain, we will forward your email to your current email address. This email account will be setup so that any email addressed to your domain (anyname@yourdomainname.com) will be forward to your current email address. You will receive free email forwarding for 90 days. If you would like to continue the service after your free period expires, pay only $6 a month (billed quarterly).

Forward my e-mail to this address:

HAVE YOUR DOMAIN RE-ROUTED
TO ANY WEB PAGE ON THE NET
Please skip this section if you are getting a hosting account

If you have a web page setup somewhere on the net, we have an inexpensive way to have your new domain name re-routed there. This is good option if you are not setting up a commercial web site, but have a free web page through your internet service provider, Geocities, etc. We charge $8 per month for this service (billed quarterly), plus a one time $10 setup fee.

If the web page that you want your domain name re-routed to has an IP number assigned to it, (for example, 208.21.240.1) please enter it here:	If the web page you want your domain name re-routed to does not have an IP number, or if you do not know what it is, please enter the URL address (such as, http://www.somesite.com/directory/file.html).
IP#:	URL:

PAYMENT FOR OPTIONAL SERVICES

If you have chosen to get any of the optional services above (hosting, or domain re-routing), please choose how you would like to be billed.

Bill me quarterly on the same credit card I'm using to purchase the domain name.
Email me a bill so that I can mail you a check or money order.

Comments or special instructions:

How were you referred to us,
or what search engine did you find us on?

CREDIT CARD INFORMATION

Credit Card Type
Card Number
Expiration Date
Cardholder Name

Your credit card will be charged a one time fee of $25.00 for domain registration. Your credit card will not be charged until your domain name has been registered successfully. If you have chosen to get a hosting account, or domain re-routing you will also be billed for these services. Please note that you will be billed separately by the InterNIC $70 for each domain name registered.

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