Hosting Order Form

WEB DESIGN

We accept Visa, MasterCard, Discover, and American Express
through PayPal.

1. Please choose a domain name, username and password

Domain Name: www.

Domain names may contain only alpha numeric characters and the minus sign "-". Other characters are not accepted. A domain which ends with .com, .net, .org, .biz, .us or .info can be registered by WhiteGyr Web Hosting for $25 for a 1 year domain registration.

You may use an existing domain that you own or you may choose to register a new domain.

Please select this box if this is a new domain name and would like to register it with WhiteGyr for $20 for 1 years.

Please select this box if this an existing domain name.

Please choose a username and password for your account below (must be lowercase & may not begin with a number):

User Name:
Password:

2. Please provide us with your contact information

Name:
First:	Last:
Company:
Contact email:	Your new account information will be emailed here.
Address:
Street:
City:	State: Zip/Postal Code:
Country:
Phone:
Home:	( ) ext.
Business:	( ) ext.

3. Please choose Service Plan and Billing Period

	Plan 1:	$120 per year
	1 email address 4000 MB Data Transfer 10 MB storage
	Plan 2:	$270 per year
	10 email addresses 10000 MB Data Transfer 100 MB storage
	Plan 3:	$408 per year
	unlimited email addresses 20000 MB Data Transfer 1000 MB storage

Billing Period: All accounts receive a 10% discount for Semi-annually billing and 20% for yearly billing.
How do you want to receive statements?
How do you want to receive Invoices?

Please choose a payment type:

Credit Card by PayPal

Email:

(Do not add spaces or hyphens)

Check
Your account will be activated upon receipt of your check.

Thank You

Thank you for choosing WhiteGyr Web Hosting. Please let us know how you heard about us.

By checking this box, I have read and agree to the WhiteGyr Web Hosting terms and conditions.

Order confirmation and instructions will be sent to the Contact e-mail.
If you have any questions, please call 1 (866) 730 1507