Order Form (please complete in its entirety)
The first information we must collect for your sign-up is the Contact Information to be used for this account.  If any problems arise with your signup, we will use this information to contact you.  Please be careful to specify a correct phone number, and most importantly of all, a correct e-mail address.

version of 05/11/03
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Contact Information:

Name:_____________________________________________________

Company/Organization :________________________________________

Address:___________________________________________________

__________________________________________________________

__________________________________________________________

Phone: _______________________________________

Fax: (optional):_________________________________

E-Mail Address:________________________________

Account Information:

Login name.  Your login name will be assigned by Z3 Internet.

Desired password (at least 6 characters):______________________

Desired domain name: Check if your choice is available

Domain name: ______________________    (second choice, if any):_______________________
[    ] check here if this domain is already registered but is being transferred to this account

Note for new .com, .net, .org, .biz domains: All new domain registrations are processed through Z3 Internet's Domain Registry Services department, providing ICANN approved registration services.  Free domain registration offer applies to ONE new domain registered in conjunction with the creation of one of our standard web hosting accounts.  Free domain registration is for the term of one year.  Subsequent domain registration renewals will be billed at a discounted rate of $17.50/year.  By registering a new domain name with Z3 Internet, you agree to be bound by the terms of the ICANN Uniform Domain Name Dispute Resolution Policy and our Domain Registration Agreement.

There is no charge for domain transfers.  We will handle all domain transfer paperwork for you. In some cases, if you have registered with an alternate domain registrar, it may be necessary to obtain from you the password for your domain record before we can update it for you.  Alternately, we can provide you with the appropriate nameserver information and you can update your domain record yourself.

Optional account add-ons:

Select a hosting package:

Please select a hosting package then calculate your initial payment, using the following table and guidelines:

 Additional Comments: (any additional info or directions for your account creation)

Agreement with Terms of Service: 

I hereby certify that I have read and understand the Terms of Service outlined by Z3 Internet and agree to abide by all of its provisions.  I also certify that I am at least 18 years of age.

Signed ___________________________________ Date ______________

Thank you for signing up with Z3 Internet!  Currently, new account applications are processed within a matter of hours after this signed order form and payment are received.  You will receive a detailed welcome message when your account is ready.  Contact sales@z3.com if you have questions about your order or the services we offer.

Mail your order form and payment to:

Z3 Internet
147 Congress Street
Jersey City, New Jersey 07307