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South Slope Web/Email Hosting Registration Form To apply for your South Slope/netINS Hosting account, print and complete this registration form, sign it, and either FAX or post mail it to the location provided. Email orders cannot be accepted. All fields are required – South Slope/netINS can't be responsible for missing information and your domain may not get registered without all information! Please print or type. |
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CLIENT INFORMATION: This should be the name of the company/organization that is applying for the South Slope/netINS Hosting account. Organization: _____________________________________________________ Address: _____________________________________________________ City/State/Zip: _____________________________________________________ ADMINISTRATIVE CONTACT: This should be the name of the person responsible for administration of the domain name, website and/or email accounts. Name: _____________________________________________________ Organization: ________________________________________________ Address: _____________________________________________________ City/State/Zip: _________________________________________________ Daytime Telephone: ___________________ FAX: ______________________ Email Address:
_________________________________________________ Your signature
indicates: Signature:
__________________________________________ Date: ___________ BILLING CONTACT: (if different) If bills for your South Slope/netINS Hosting account and/or bills for the domain name should not be sent to the person listed in the above section, list the person that bills should be sent to here. This should be a person, not a department. Name:_____________________________________________________ Organization: _________________________________________________ Address: _____________________________________________________ City/State/Zip:_____________________________________________________ Daytime Telephone: _________________ FAX: _____________________ Email Address:_____________________________________________________ |
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PAYMENT INFORMATION: Select the level of South Slope/netINSHosting service you've decided on here: Premium Servers Mail Hosting * Billing for South Slope/netINS Hosting email accounts is based on the maximum number of users you have added to the system at any one time over the course of a month. In the event that you add no more email addresses than the number allowed, you will be billed for the price listed above. If you add additional accounts above the allotted amount your account will be billed $2.00 per month for each additional account. An invoice detailing the largest amount of users you had activated for the billing period will be issued monthly. |
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ACCOUNT CONFIGURATION INFORMATION: Enter the domain name for your South Slope/netINS Hosting site in the server name blank. Some examples of domian names are: iastate.edu, apple.com, and netins.net Server/Domain Name: ________________________________ I need South Slope/netINS to register my new domain name: Yes: ___ No: ___ How many years would you like to register your domain for? (Place an X in the box to the right of the term you would like to have netINS register your domain for)
If your domain name is already registered, would you like to have it transferred to netINS control? Yes: ___ No: ___ South Slope/netINS, Inc. will charge you for use of a domain name registered in the ".com", ".org", or ".net" top level domains on your first bill. Renewal notices will be sent to your administrative contact email address near the end of the term you have selected. Prices subject to change. For more information about South Slope/netINS domain registration visit http://webhosting.netins.net/domainreg/. To check if the domain you want is available visit http://webhosting.netins.net/domainreg/cgi-bin/form.html Email: South Slope/netINS Hosting provides at least 5 total email addresses using your domain name. You can set up your email accounts on an administrative web site that we'll provide for you. You'll be able to use the username and password we provide to you to gain access to the site and administrate your users. If you choose, we can point all mail for your domain name at a different mail server (possibly one that you operate in your office). If you have a mail server that you would like us to forward your email to please name it here: ___________________________________________ |
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Please MAIL or FAX application to: |
South
Slope Cooperative Communications Attn: Jim Hanson |
Fax: (319) 665-2299 |
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netINS Internal Use Only Customer No: ____________________ Date Processed: _______ |
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South Slope/netINS Hosting Terms and Conditions 1. By signing this registration form and agreement, you
(customer) agree to the following terms and conditions of the service described
below. 5. South Slope/netINS, Inc. makes no express or implied
warranty of any kind. There is no express or implied warranty of
merchantability or fitness for a particular purpose for the services to be
provided by South Slope/netINS. South Slope/netINS makes no attempt to verify
accurate receipt of any message and is not responsible for any loss of data
resulting from delays, nondeliveries, incorrect
deliveries or service interruptions, including those caused by negligence,
errors, or omissions of South Slope/netINS, nor for consequential damages
regardless of their cause. |