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http://www.IBCMerchantAccounts.com

UK Website Hosting

Please complete the following application with all information that applies to you to order your new hosting plan. If you wish to order more services, you will be given that option after submitting this form.

IMPORTANT: The following application will provide us with enough information to understand your business. Completing this application DOES NOT commit you to the account, and ALL information is kept confidential and stored on our secure servers for a minimal amount of time.


Contact Information
Business Name (if company)
Contact Title
*Contact Name
*Contact Surname
*Contact E-mail
*Contact E-mail Confirmed
*Telephone
Mobile Telephone
Alternative/Business Telephone
Best Time to Call
Facsimile

Hosting Account Details

Plan    
Lite $310 (30 MB)
Basic $400 (75 MB)
Premium $520 (100 MB)
Application $1,100 (150 MB)

Domain Registration needed?
yes no
If yes, what type? Standard - $75
  Anonymous - $100

If yes, Requested Domain Name
Extension
*can be any extension, including that of another country (eg, .uk, .co, .au, etc.)

If no, Current Domain Name
Security Option Shared Secure Certificate
  Private
Username
(less than 16 characters)
Temporary Password
(less than 8 characters)

E-mail Addresses    
Username Password Forwarding Address
Username Password Forwarding Address
Username Password Forwarding Address
Username Password Forwarding Address
Username Password Forwarding Address
Username Password Forwarding Address

Check here if you will need more e-mail addresses


Corporations (IBCs)
Belize Corporation
Panama Corporation
Costa Rica Corporation
Dominica Corporation
Seychelles Corporation
Singapore Corporation
E.U. Corps -
U.K. Corporation
Gibraltar Corporation
Malta Corporation
Cyprus Corporation

Trusts
Belize Trust

Merchant Accounts
U.S. Merchant Account
Offshore Merchant Account

Bank Accounts w/Debit
Caribbean Personal
Caribbean Corporate
Belize Personal
Belize Corporate
Panama Personal
Panama Corporate

Debit/Credit Cards
Secured Maestro Debit Secured Visa Credit
Virtual MasterCard Credit

Website Hosting
U.K. Hosting Account
Costa Rica Hosting Account
Belize Hosting Account
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