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| Selected Hosting Plan: |
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| Email Service: |
Yes. Enable the
No. I already have email service elsewhere
or I don't use email on this domain
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Please provide us with the Domain Name you will be Hosting |
| Domain Name http:// |
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| Billing Information: |
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| Company: |
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| First Name: |
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| Last Name: |
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| Address: |
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| City: |
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| State/Province: |
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| Zip Code: |
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| Phone Number: |
()
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| Fax Number: |
()
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| Email Address: |
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| Referral Information |
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| Referred By: |
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| Referrer's Email: |
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| Setup Information |
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Initial User ID: |
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Note: 6-16 characters. Use lowercase letter and numbers
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Initial Password:
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Note: 6-16 characters. It is case sensitive, needs to mix case, numbers and special characters and may be changed later |
| Dedicated IP for SSL use:
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Not Needed or its already in my package
Yes, I need a dedicated IP and understand there is an additional charge of $5/month
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| Special Instructions: |
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Pixelgate will contact you for your payment information.
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