Domain Registration Secure Order Form

Your Domain Name

Domain Name *

TLD *

Estimated Order Total

$ 0.00

Would you like to order web hosting for your new domain? *

Yes
No

Account Information

Business Name

Contact *

First

Last

Email *

Phone *

Billing Address *

Street Address

Unit / Apartment / Suite

City

Province

Code Postal

Credit Card Information

Account Holder Name *

Credit Card Number *

Expiry Month *

Expiry Year *

CVV

Authorization

Authorization *

I agree to the terms and conditions *

Please note once your order is received an Internet Lightspeed CSR will call to verify the information you supplied.

I acknowledge that this is a prepaid service. The plan and payment period you have selected, as well as a deposit equal to the monthly billing rate for your selected hosting plan, will be charged today. All fees are payable on or before the 1st day of the next billing period.

Once provisioning and activation is complete the account becomes active immediately and billing commences immediately. Due to technical reasons this cannot be delayed.

All prices as well as other aspects of our services are subject to change without notice.

To show your acceptance of and willingness to be bound by the complete Terms and Sonditions listed on our website, please add you signature in the provided panel, then tick the box "I AGREE" above and click Submit at the bottom of this form. Click here to view our complete Terms and Conditions.

Prices indicated for the various plans do not include the one month deposit, applicable taxes, tariffs, or any applicable set-up fees. All prices as well as other aspects of our services are subject to change without notice.

Signature *

(use your finger, stylus, or mouse to sign in this space)

DOMAIN REGISTRATION- ORDER FORM

Your Domain Name

Account Information

Credit Card Information

Authorization