| * Country
....................... |
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|
If
Not Listed
|
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| * ZIP/Postal Code
............ |
|
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| * State/Province ............. |
|
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| * Phone ......................... |
code
#
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| Fax ......................... |
code
#
|
| * Domain Name |
|
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| Register
your domain name for $14.95 per year |
|
If this is a transfer, please give the name of your current
host.
|
You may enter your own password or leave this box
blank if you want us to randomly generate your password (cAsE
sEnSiTiVe) PASSWORD MUST BE A COMBINATION OF LETTERS AND NUMBERS
AND MUST BE AT LEAST 5 CHARACTERS LONG:
|
Please
type your full name AND email address in the box below. By doing
so and submitting this form to Dyntex you are agreeing to
the terms, conditions and acceptable use policy previously set
forth by Dyntex. This is a binding document. By placing this
order you are requesting service from Dyntex, and therefore
do incur all fees associated with the provisions of said service.
You should receive your account logins within 24 hours.
* I AGREE to all items in the terms,
conditions and acceptable use policy:
This
document will not be "signed" in the sense of a traditional
paper document. To verify the contents of this form, the signatory
must enter any combination of alpha/numeric characters that
has been specifically adopted to serve the function of the
signature, preceded and followed by the forward slash (/)
symbol. Acceptable "signatures" could include: /john doe/;
/jd/; and /12.04.2003/. For example: if your name is John
Miller, you could type /John Miller/ below.
* Signature:
Date:
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