Order a Web Whirls Hosting Account

Web Whirls - Hosting - Order an Account

• Bronze
• Silver
• Gold
• Platinum
• Comparison
• Order Form

Your Name:

First Name:

Initial:

Last Name:

Your Address:

Company Name:

Type of Business:

Street:

City:

State/Province:

Zip/Postal Code:

Daytime Phone:

Home Phone:

Fax:

E-Mail Address for Domain Registration:

E-Mail Address to send Account Information to:

Billing Address: If not the same

Billing Name:

Billing Street:

Billing City:

Billing State:

Billing Zip:

Billing Phone:

Billing E-Mail:

Domain Name:

Domain Name: Check Domain Name

Domains are registered for $15 USD per year.

Domain name is already registered:

Web Hosting Account Option:

United States Bronze	$10.00/Month	$10.00 Setup	$20.00 Total
United States Silver	$15.00/Month	$30.00 Setup	$45.00 Total
United States Gold	$20.00/Month	$30.00 Setup	$50.00 Total
United States Platinum	$25.00/Month	$30.00 Setup	$55.00 Total

Canadian Bronze	$15.00/Month	$15.00 Setup	$30.00 Total
Canadian Silver	$22.50/Month	$45.00 Setup	$67.50 Total
Canadian Gold	$30.00/Month	$45.00 Setup	$75.00 Total
Canadian Platinum	$37.50/Month	$45.00 Setup	$82.50 Total

NOTE: Your Domain Registration fee ($15 USD)
is not included in the above charges.

Password for your account: (6-8 Characters in length)

Payment Method:

Check (Web Whirls will set up your account upon receipt of your check)
      Please Remit Payment to:
      Web Whirls
      1015 Regent St.
      Fredericton, N.B.
      Canada
      E3B 3Y9

Visa

MasterCard

All domain name registries require Credit Card info to register domain names.

Credit Card Number:

Expires:

Name as it appears on Card:

Credit Card Billing Address Zip Code:

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