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Secure Reseller .COM, .NET and .ORG Domain Name Registration Form

Note: This form is for registering .COM, .NET and .ORG domain names only. If you'd like to register a domain name with one of the other global TLDs, please choose the appropriate form below: Note: If you are not an Internet Connection Reseller, please use this form.

If you would like to register your client's Domain Name for use at a later date, we will still park it for you at no charge until they are ready to serve it.

If your client already has a domain name and you would like to transfer it to our servers, please use this form.

Reseller Information

Reseller Admin: (required)
Reseller's Primary Domain Name: (required)
Register me as:
the Administrative Contact
the Billing Contact
the Technical Contact

Domain Name Information

Domain Name: (required)
Registration Term: (required)
  Please lock this domain name. What does this mean?
Username: (required)
Password: (required)
Retype Password: (required)
The username and password will enable you to make changes to your domain name information in the future. The password can only contain the characters a-z and 0-9.
Server Platform:

Organization Information

Organization:
This can be your personal name.
Street Address: (required)
City: (required)
State/Province: (required)
ZIP/Postal Code: (required)
Country: (required)
Contact Name: (required)
Email Address: (required)
Phone Number: (required)
Fax Number:

Billing Information

A Note on Credit Card Security

In the interest of protecting your credit card information, Internet Connection asks that you provide CVV2 credit card verification information.

CVV2 is another number that's printed on the back of Visa and Mastercard and on the front of American Express cards. Here's an example of some CVV2 numbers.


Card: (required)
Credit Card Number:
Expiration Date:
Name On Card:
CVV2 Number:

Comments

Please double-check all of the information you entered above before submitting the form.

Your client's domain name will be active approximately 24 - 48 hours after we receive this form.

If you have already ordered your client's new server, we will provide you with an IP Address to upload and view your client's site with until their domain registration is complete.

If you haven't already established your new client's account with us, please fill out the Reseller Account Order Form so we are ready when your client's new domain name becomes active.

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