Everex: Web Hosting Account Setup Application

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Web Hosting Account Setup Application
$10 SET UP FEE - NO BANDWIDTH CHARGES!Because of the growing number of PayPal users (over 11 million), Everex 
        will implemente a fully automated, 100% secure billing system powered 
        by PayPal. You can pay for your hosting account with any major credit 
        card, debit card, electronic check or by instant bank transfer.

	Company Name:
	
	First Name:
	
	Last Name:
	
	Address1:
	
	Address2:
	
	City:
	
	State:
	
	Zip:
	
	Email:
	
	Evening Phone Number:
	--
	
	Day Phone Number:
	--
	
	Domain Name:
Whois Search
		
	 Register My New Domain  *Read Note Below*

	 Transfer My Existing Domain

	 I will handle my own transfer or registration

	Desired Account User Name:
(8 chars max)
		
	Comments or Questions:
	
	Enter your message here!
	
	*Note: If you selected the "Register My New Domain" 
      radio button, Everex will contact you by phone to register your domain using 
      any major credit card. New domain registration is $14.95 per year with Everex.

	
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