SECURE ORDER PAGE

ACCOUNT INFORMATION

Hosting Package : (required)

Server Type : (required)

Domain Info : (required)

Domain Name to Transfer/Purchase: (required)

Username Preference : (no more than 8 characters)

Password Preference : (no more than 8 characters)

 

CONTACT INFORMATION

Customer Name : (required)

Customer Address : (required)

City: (required)

State/Province: (required)

Postal Code: (required)

Country: (required)

Phone Number : (ALL orders are verified via phone prior to activation)

Customer Email Address: (required)

 

BILLING INFORMATION

Billing Preference

Credit Card Type : (required)

Credit Card Number : - - - (required)

Expiration Date : (required)

Credit Card Holder's Name (exactly as it appears on card) : (required)

Credit Card Holder's Address (where bill is sent) : (required)

City: (required)

State/Province: (required)

Country: (required)

Postal Code: (required)

 

ADDITIONAL INFORMATION

How Did You Hear About Us : (required)

Comments:

I agree to Feisty Chihuahua's terms & conditions:

PLEASE NOTE: ALL ORDERS ARE VERIFIED VIA PHONE PRIOR TO ACTIVATION

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