Business / Organisation:

Street address:

City:

State / province:

ZIP / Postal code:

Country:

Email address:

Phone:

Account type you're signing up for:

I like to pay: monthly every 3 months every 6 months once a year

You can pick your own username and password for your account. These will be used for logging in to your account to upload your pages etc. Please pick a password that is not trivial and at least 5 characters long.

Username:

Password:

If you like, you can register a domain name to go with your account. The cost for this is $15 per year. You can register a domain for up to 10 years. Please note that you can only register .com, .net, .org, .biz, .info and .name domain names using this form. Other top level domain names might be available at a different price. If you are interested it this, please enquire seperately.

By default the domain is registered to the same name as the one you are using to sign up for with your account. If you like to register the name to another name or address, you can make note of this in the "comment" section below.

Existing domain names can also be put under your account. No additional charges are applied for this. We'll contact you about how to best faciliate for the changes that will have to be made to your domain name registration

Yes, I'd like to have a domain name to go with this account.

Domain:

Register it for a period of:

Comments, questions and other notes you can put here:
If you were referred by someone else to Web Conquest, you can put their name and account name here and they'll receive a 10% bonus on the hosting services you acquire from us.

I like to receive the Web Conquest newsletter and updates delivered te the email address given above.

I have read the service contract and agree to abide to all rules and conditions made in it.