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Thank you
for coming to our web hosting order page.
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Who referred you: Name and/or Domain name | If you refer someone, you get a month free! |
| Coupon Code Goes Here: | |
| Name: | |
| E-Mail: you@yourISP.net | NO FREE EMAIL ACCOUNT HERE. Use your ISP email address. |
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Your Domain , ie: yourdomain.com
If more than one, list them in the text area below, and list your main one here. |
WWW. |
| Do you own your domain name already? |
Already own your domain:
Want us buy domain for you: If we purchase the domain for you, it will be fully in your name. Pricing is $10.25 per year, when we buy it for you. |
| Mailing Address: | |
| City, State, Zip: | , , |
| Phone: | |
| Web Hosting Plan: |
There is a $20.00 set up fee. |
| Payment Type | Online Check Visa Master Card AE Discover/novus PayPal |
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How many Months are you paying for?:
ie: 1, 3, 6, 12, this will be your automated billing cycle. |
12 mo= 1 mo free, 24 mo= 2 months free |
| Credit card Section: | |
| Name on Card: | |
| Card Numbers: | |
| Expiration Date: | |
| CVV: 3 digit number on back of card | Amex - 4 digits on front of card |
| Card Billing Address (if different from above) | |
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Online CHECK Info (USA only) Please use the check at the right to complete the information below. NOTE: After initial payment, we use autodraft to print a check each month on the 1rst of each month. | *The sets of numbers are not always in this order |
| Name On Check | ("A"from above) |
| Address on Check: | ("A" from above) |
| Bank Name: | ("B"from above) |
| Bank City & State: | ("C"from above) |
| Check Number: | ("D"from above) |
| A.B.A. Fraction: | ("E"from above) |
| Routing Number (9 Digits): | ("F"from above) |
| Account Number: | ("G"from above) |
| All Numbers From Bottom of Check: (see instructions to right) This is Redundant, but it will insure accuracy. | ![]() |
Any special notes may go here. | |
| We may call you to verify your order. You will be sent a receipt of payment when the billing is done. Also, be sure the e-mail address listed above works, so you will get your receipt, and welcome e-mail with your log in information. You should whitelist any address @superior-host.com in your email program. Thank you, Tim LeGrand - Owner | |