|
| 1. Customer Details |
|
| First Name: |
* |
| Last Name: |
* |
| Primary Email Address: |
*
* |
| Secondary Email Address: |
** |
| |
|
| 2. Domain Name and Billing Cycle |
|
| Domain Name (*): www |
|
| Hosting Plan: |
DHS Professional Plan |
| Billing Cycle: |
|
| Total Cost: |
|
| |
|
| 3. User Details |
|
| Username (6 - 12 characters only): |
*
*
|
| Password (6 - 20 characters only): |
**Password should be more than 6 chars.
|
| Confirm Password: |
** |
| |
|
| 4. Miscellaneous |
|
| Preferred Data Center Location? |
|
| How did you know about us? |
|
