Order Reseller Platinum

MinistryHosting.org Secure Order System	500 Trombley Bay Lane Atlanta, GA 30044 Phone 770-979-5242
Reseller Platinum Plan Hosting - $69.95 Per Month

Click Here To Check The Availability Of A Domain Name
(It will open in a separate window so you won't lose the info in this form)

Set-up is generally completed the same day and usually in less than one hour, but may take up to 24 hours depending on circumstances. We will contact you after setup with a "Welcome" e-Mail which will include your account information and domain name server change information. By submitting this order form, you warrant that you have read and agree to our Terms of Service.

* Indicates a "Required" field.

Domain Information
Your Domain Name*	www. NOTE: Be careful! No refunds for misspelled names registered for you.
* New Domain Registration Don't register me (I will handle my Domain Registration) New Registrations are $34 for TWO full years for: .com .net .org .us .info .biz
Second Choice Name	www. Only needed if this is a NEW registration and in case 1st choice is not available.
Login Name Request* (3 to 8 lower case characters):	Do NOT choose generic names like info or support. If your choice is not available we will assign one for you. An email address is auto created using this login.
Plan / Payment Choice*
How You Found Us*
If Found In A Search Engine Please Tell Us Which One
Any Comments?
Additional Account Features For Your Own Reseller Account Only
I Want Super Shop Cart:*	More Info - Super Shop Cart
I Want RealServer Access:*	More Info - RealServer
I Want To KickStart My Site:* Submit to over 400,000 engines	More Info? Do Not Overlook The Importance Of This
I Want SuperStats:* Monitor hundreds of valuable stats for your site	More Info? Starts at $9.95 and Depends On # of Page Views Each Month
Owner / Contact Information
First Name*
Last Name*
Company (If Any)
Your Street Address*
City*
State*
Zip Code*
Country*
Phone With Rea Code*	Numbers Only No Dashes or Dots
Mobile Phone With Area Code	Numbers Only No Dashes or Dots

Your e-Mail Address*	This MUST be an address outside the domain you are setting up. Your Login info will be sent here.
Second e-Mail Address If At All Possible	An additional address outside the domain you are setting up. Helps us contact you if there is a problem

Credit Card Account Billing Information
Credit Card Type	MC VISA AMEX (Select One)
Card Number
Expiration Date	Should your card be expired when a renewal of services are due, you authorize us to extend the Expiration date.
CVV2 Number	What's This?
Name as it appears on Card
Secondary Name on Card
e-Mail for Billing Receipts
Credit Card billing address must match Owner Info on previous page or be provided below:
Card Billing Address
City, State/Country, Zip	State Zip
Telephone Area With Code	Numbers Only, No Dashes or Dots
Submit this form ONCE ONLY If paying by credit or debit card, I agree by submitting this order to allow MinistryHosting.org/The GraceNet to charge my debit or credit card an initial payment for web hosting services, either one month or one year of hosting according to the payment cycle selected and any domain registration fees (if applicable). I also agree to allow MinistryHosting.org/The GraceNet to charge my debit or credit card monthly or annually on my account renewal date. This agreement will be in effect until cancellation by either party in writing at least 30 days before the next account renewal date.

Submit this form ONCE ONLY