Web Hosting Secure Signup

Domain Name

If you already own your own domain name please continue. Otherwise Click Here to check availability.

Enter your domain name: * (example: mynewdomain.com)

Please choose a Hosting Plan:

Check here for Windows hosting. ($5/month additional).
By default, your hosting account will be set up on a Unix web server.
Optional Windows hosting is required to support Microsoft Frontpage, MSSQL, ColdFusion or ASP.net

Check here if you'd like Wordpress set up for you. (Free!).
Wordpress is a very popular option that makes it easy to design your own great looking website!


Section A (Billing)

Name: *

Company:

 

Street Address: *

 City: *
 

State: *

Zip code: *

 

Phone Number: *

Fax Number:

 

Email Address: *

 

 

Desired Password for Website Access (min 5 characters): *

I want to pay in advance for one year of hosting and get free domain registration for one year.

How would you like to pay for your web hosting?
Please select one of the following payment options:

Automatic Credit Card Payment:

Select Card Type
 
Card Number
 
Expiration Date

Automatic Checking Withdrawal:

Bank Name
 
Routing Number
 
Account Number

Paper Bill, $2 per month additional processing fee

Email my bill to the following address:

I am a new customer or I want my hosting billed to a separate account.

Domain Information

Please select an option:

This is a new domain which I would like Brainstorm to register for me for

This is an existing domain that I have registered elsewhere, and I'd like Brainstorm to transfer and manage it for me. I understand that if I select this option I will be charged $25 and my domain registration will be extended one year.

Web address of current registrar:

Username:

Password:

I will manage my domain registration myself.

Comments

Please enter any additional comments below:

* required fields

Policy: By clicking Accept below, the Customer acknowledges notice of, accepts and agrees to all of Brainstorm Internet’s Standard Terms and Conditions and its Acceptable Use Policy listed at http://www.gobrainstorm.net/termsandconditions.html. By signing this form, I understand and authorize the total charges noted above for web hosting and domain registration services. If I have requested Brainstorm Internet to manage my domain name I understand and agree that Brainstorm Internet will keep my domain name current on my behalf. I accept responsibility for annual domain registration renewal fees billed to my account and agree to provide Brainstorm Internet with written notice no less than 60 days prior to my domain name’s expiration date if I wish to discontinue ownership of this domain name and allow it to expire.


To help reduce spamming abuse of this online form, we utilize a security policy which requires you to enter the random text you see in the box below.