InterSurge Internet - Linux Web Hosting

InterSurge Order Form
New customers only- current customers please use the Additional
Account form in the "My Account" section of your control panel.

If you wish to access a secure version of this form, click here.

1. Client Information
Name (first, last):	,
Company Name:	(Optional)
Address: (This must be same address as listed on your credit card)	(Optional)
City, State	,
Zip Code:
Country:
Phone Number:
Fax:	(Optional)
E-mail:
Payment Method
Name on Credit Card
Credit Card Number (no dashes)		(We Accept, VISA, MasterCard, and American Express)
Exp. Date (MM/YYYY)

How did you find us:

2. Order information

Domain Name:	http://www.
If this is a new domain, please check the availability of the domain here. New.net clients: Please enter domain in the form of domain.ext.new.net

Requested username:

Please Select a Plan:
Plan details are listed here.

Contract Length:

Please install FrontPage Extensions on my account

Please check this box if you agree to the Terms and Policies

Comments:

If you require a unique IP address, please note this in the comments field, as well as your reason for requesting a unique IP. The vast majority of web sites on the Internet do not need a unique IP address. The only reasons one would require a unique IP include using a 3rd party DNS service to point your site to InterSurge, or having a unique secure server certificate for your domain name.

Account Setup Policy
All new accounts will be activated within 24 hours following receipt of payment. Clients paying by check may place an order using this form, and then send payment to the address listed on the invoice they receive. As per our money back guarantee, any orders cancelled within the first 30 days will be given a full refund, less any setup fees.

You will be e-mailed a complete "Welcome Letter" containing the URL to your Online Control Panel, your username, FTP hostname and IP address. You will then be able to administrate and begin uploading your files to your new web site immediately. You will be able to use your IP address (sent to you in your activation notice) to access your website

For fraud prevention purposes, your IP address will be recorded with this transaction.
We will report and prosecute all instances of credit card fraud.