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Shared - Limited CPU (Flat Rate) Plans - Order Form

** All information is encrypted via PGP to ensure your privacy and safety **
Tell us about your domain...
How did you find us? (Banner? Search engine? Friend?)
Type of Registration:

Domain Name:

(Click here to check availability)
Want us to register? (We can register your domain and pass the fees on to you)

Choose a Password:

(A mix of letters/numbers are best)
Pick your plan...

Choose your plan:
Tell us about your traffic...


Please estimate

your DAILY traffic.

 Unique visitors per day
Page views/day
MB of transfers per day
Choose the features you want...
Web Log Analysis? FP 2000 Extensions? CGI: Perl: SSI: SSL:
Enter your Billing Information...

 

 

International Customers - We require a faxed or scanned copy of your card/check and picture ID before we can process your order. Please e-mail scanned images to billing@rapidhosts.com or fax your information to 1-877-741-7357 (North America) or +1-864-472-2071 (International)


Card Number (example: 1234-5678-9012-1234)
 CVD# (Last 3 digits printed on back of card)
Expiration Date (MM/YYYY)
Name as it appears on your card

Checking account information ($5/month surcharge)
 Routing Number (first 9 digits)
Account Number (second 9 digits)
Check Number (last 4 digits)
Bank Name (as printed on check)
Name on the Account
PayPal Users: Do not need to fill out the above information. We will send you a request for payment to e-mail you provide below. Your account will be processed once we receive a verified payment.

Please note that charges on your bank statement will show as: "SOLUTIONS UNLIMITED"
Contact Information
This is who will be responsible for all charges from RapidHosts for web hosting services.
Information should match that of your credit card.
Company Name:
Your Name: (As it appears on your credit card)
Billing Address1: (Where your credit card statement is mailed)
Billing Address2:
City:
State/Province:
Postal Code:
Country:
Phone Number: (Must be a valid phone number)
Fax Number:
Your E-mail: (Valid e-mail address... No HotmaiL, etc.!!)

Please note that by submitting this form, you agree that:

1. You have read, understand, and agree to be bound by our Terms of Service
2. You authorize our parent company to bill you on a recurring basis
3. You understand that you will be billed monthly until your service is canceled by you or us.

Please be sure to double check your information for accuracy. Incorrect information may delay the processing of your order.

** Charges on your bank statement will appear as "SOLUTIONS UNLIMITED" **

After clicking submit, your information will be encrypted via PGP and sent to our secure server for processing. This may take a few seconds.

You will receive a confirmation via e-mail when your account setup is complete.

Thank you for choosing RapidHosts!

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