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Dyntex Web Hosting Services
Secure Webhosting Order Form
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  •   STEP 1
    * Required field

    * First Name
    * Last Name
    * Email
       Company
    * Address
    * City
    * Country .......................
    If Not Listed  
    * ZIP/Postal Code ............  
    * State/Province .............
    * Phone ......................... code #
       Fax ......................... code #
    * Domain Name

       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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