HoustonHost.com PayPal Web Hosting Order Form

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PayPal Users Secure Order Form
Contact information:
*Name:
Organization:
*Street address:
Address (cont.):
*City:
State/Province:
State (if other than the United States or Canada):	***Leave blank if you live in the USA or Canada.
*Zip/Postal code:
Country:
*Home Phone:
FAX:
E-mail:	Note: This is the address where we send billing information
How Did you find us?	If a customer told you about HoustonHost.com, please tell us who. (Their domain name?)
Domain Information:
*Domain Name: http://www.	(example houstonhost.com , houstonhost.net , etc.)

If this is a new domain who is to handle getting the new name:
How many years do you want to pay for on the Domain Name:
Login information:
User Name: Note: 4 to 8 characters Password: Note: 4 to 8 characters
The user name must start with alpha characters and consist of alpha characters, numeric characters, minus sign '-' or underline '_'.
PayPal Billing Information:
*Your email address used at PayPal:

Plan Information:
Which hosting plan:

Payment plan:
	All accounts receive 5% off 6 month and 15% off yearly billing
Please read Terms and Conditions
Primary Nameserver: ns1.411server.net IP: 207.44.176.118 Secondary Nameserver: ns2.411server.net IP: 207.44.177.45

Mailing address if needed for check payments:

HoustonHost
P.O. Box 12
La Porte, TX 77572

We have no setup fees!! No Hidden Fees!!!

Use of this site is subject to certain Terms and Conditions.