Hosting Application

Thank you for choosing UltiHost! Your application will be processed as soon as possible, at which time we will send you an invoice via email. Upon receipt of payment, we will activate your hosting account and email you all the details! Future Invoices will be emailed approximately 30 days preceding the due date.

This form is to pay by CHECK - if you wish to pay by credit card, please use your BACK button and select that option.

Please fill out all areas unless marked "Optional".

Your Name (First and Last) :
 
Company Name (if applicable - Optional) :
 
Street Address :
 
City (or town) :
 
State :
 
Zip :
 
Phone (with area code) :
 
Your Email :
 
Your Domain Name (Example: mybiz.com) :
 
Hosting/FTP Username (3-8 letters, case sensitive! Note: This name should not be a name you may want to use as an actual Email Address at your Domain. The Username CANNOT be changed.) :
 
Hosting/FTP Password (6-8 letters or characters, case sensitive! This can be changed later.) :
 
Choose a Hosting Plan
Plans available are:
Standard 6-Months for $108.00
Corporate 6-Months for $150.00
If you wish to pay monthly, you must go BACK and choose the Credit Card Plan