Panix, New York's First Internet Service Provider

Cheap Web Signup and Domain-Name Registration Form

Please do not fill out this form until you are ready to place an order. Submission of this form is an agreement to purchase the indicated Panix service, and you will be billed accordingly.

Use this form to sign up for your Cheap Web service with Panix and to register your domain.

If you have questions about the service, click here to see a description.

  1. Name (Last,First):

  2. Phone Number:

  3. Are you creating a new domain or moving your existing domain to Panix?
       Domain Name:

  4. What is your Panix account? (If you have more than one, which one are you adding Cheap-Web to?)
    @panix.com
    If you do not have a Panix account, please call us for one at (212)741-4400.

  5. What would you like your e-mail address at your domain to be?

    @yourdomain

    If you leave this field blank, we'll make it the same as your existing address @panix.com.

  6. Organization Using Domain Name (if you personally, enter your full name)

  7. Street Address:

  8. City, State, & Zip:
      

  9. Country:

  10. How would you like to pay for this?
        Choose "yearly" and pay for a year in advance to get 12 months for the price of 10 !

  11. How you learned about Panix:

By clicking the "Sign Up!" button below, you agree to purchase Panix Cheap Web service at the price listed, and under the terms posted, as of today's date on the Panix Cheap Web details page and the Panix Rules of Use. You affirm that you understand these terms and restrictions, and in particular, are aware of the possibility of extra charges for Web traffic ("hits") to your site in excess of 1 GB per month.

If you have any questions about how to fill out this form, please call us at (212)741-4400.

© Copyright 1999, Public Access Networks Corporation
webmaster@panix.com | Last updated November 15, 1999