PhutureNet Sign-Up Form

Important :

Step 1 : Primary Contact

Name
Company
Address
Address
City
County
Postal Code
Country
Day Phone
Evening Phone
Fax Phone
* Primary E-mail Address
Secondary E-mail Address

* Note :

Check this box if the owner of this account will

be different than the primary contact above.

Step 2 : Marketing (optional)

How did you find out about us?

What type of computer environment do you use ?

How do you access the Internet?

What is the speed of your Connection?

What is your web browser of choice?

Step 3 : Select the services you wish to purchase

Basic Web Account

and

New Domain and Web Account

and

Transferred Domain and Web Account

and

New Domain Registration Only

and

This Month's Special !

Special prices good through first year of service.

Additional Services to Add to Your Account

E-mail POP Account

and

E-mail Alias

and

E-mail Forward

and

E-mail Auto Responder

and

Mail Form cgi script

and

Step 4 : Choose Payment Period

Important Note :

Monthly Payments

This choice means you wish to pay for your services on a monthly basis. You will be charged once every month on the same day you signed up.

Quarterly Payments

This choice means you wish to pay for your services on a quarterly basis. You will be charged every three months the equivalent of three monthly fees.

Yearly Payments

This choice means you wish to pay for all 12 months in advance.

Step 5 : Select a password for your account

Submit your details