Find a Domain


Web Hosting Application Form

(All prices are quoted in Barbados dollars)

Personal Information
Full Name:
Company Name:
Contact Name:
Contact E-Mail: (should not be an address at the requested domain name e.g. user@yourdomain.com is not acceptable)
Home Telephone :
Work Telephone :
Cellular/Mobile:
Home Address:
Work Address:
Send my bills to: Home Address Work Address

Hosting Information
I require Hosting for my Site:Yes No
Hosting Plan:
Additional Storage: @ $11.50/month VAT Inclusive for each additional 100MB
Additional Bandwidth: @ $11.50/month VAT Inclusive for each additional 1GB
Domain:
Current/Requested Domain: 
Email Account: (this is the email address at your requested domain e.g. user@yourdomain.com)

Payment Information
Payment Method: Cheque Cash
Payment Plan: Semi-Annually Annually

I have read and agree to the Acceptable Use Policy as well as the Terms and Conditions.