WebHosting Reseller order form

This is our reseller program order form. We set up our resellers accounts manually.
Welcome to superior-host.com , where being a reseller is an enjoyable experience.

Your Name:

Domain Name:

New domain Registration:
Transferring my domain:

Email Address:

Phone Number:

Company Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

POLICY:
Check here to indicate you have read and agree to abide by our policies and understand they may change without notice. Also, it is your responsibility to insure your customers also abide by our policies.

Please let us know how many sites you will be moving over to us within the next 30 days:

Choose the Reseller Hosting Plan You Prefer:

Notes:

Credit card to use for monthly billing: If you choose to pay by Check, we will have you go to a form to enter your check details. We print checks electronically, and deposit them on approximately the 3rd of each month.
We also accept paypal.

Name on card:

Card holder's Address (if different than above personal information):
If using PayPal, put PayPal email address for invoices here:

Card Number:
example: xxxxxxxxxxxxxxxx no spaces please.

Double check number please.
Expiration Date
(mm-yyyy):

By clicking on the submit button you have agreed to abide by the policies set in place for the good of our valued customers and our servers, and understand that if you break them your account can be deactivated or deleted without notice!

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