Planetmind Domain Hosting Sign-up Form

Use this form to request a domain to be registered for you. All yellow fields are required. Hosting is /month, or /year. Domain Name parking (just reserving the name) is setup (use this form).

Domain Name Desired:

REGISTRATION INFO

Registrant Name:

Hosting Plan:

Solar Hosting +$5/mo
Note: all hosting is wind powered.

Billing Cycle Desired:

Monthly
Quarterly
Yearly

Registrant Company:

Address Line 1:

Address Line 2:

City:

State: Zip:

Email:

Phone:

BILLING INFO (if different)

Bill to Name:

Bill to Address Line 1:

Bill to Address Line 2:

City:

State: Zip:

Email:

Phone:

ACCOUNT INFO

Administrator Full Name: (This will be the name of the person primarily in control of the site)

Administrator Email: (For technical contact)

Administrator Phone: (For technical contact)

Admin account username: (this will be the login used to maintain the site, as well as the main email address. 4-12 characters.)

Admin account password: (please use 4 or more characters, and 1 or more numbers or special characters (!,#, etc))

Password again:

Supplemental Email addresses
(You may have up to 4 additional email addresses per domain. Extras are per month)

USERNAME PASSWORD CONFIRM PASSWORD

Comments
(Include any special instructions here.)

How did you hear about us?

PAYMENT INFO

Check, Visa and Mastercard are accepted for payment. Please send checks to:

Planetmind Internetworks
PO Box 1244
Nederland, CO 80466

Credit Card Information

Name on Card:

Card Number:

Exp. Date (mm/yy):

We usually have domains registered within 24 hours; DNS propigation usually takes 48-72 hours before you site is accessible to the world.