netINS Web/Email Hosting Registration Form
Rev: Feb 2005

To apply for your netINS Hosting account, print and complete this registration form, sign it, and either FAX or post mail it to the location provided. Email orders cannot be accepted.

All fields are required - netINS can't be responsible for missing information and your domain may not get registered without all information! Please print or type.

CLIENT INFORMATION: This should be the name of the company/organization that is applying for the netINS Hosting account.

Organization: _____________________________________________________

Address: _____________________________________________________

City/State/Zip: _____________________________________________________

ADMINISTRATIVE CONTACT: This should be the name of the person responsible for administration of the domain name, website and/or email accounts.

Name: _____________________________________________________

Organization: ________________________________________________

Address: _____________________________________________________

City/State/Zip: _________________________________________________

Daytime Telephone: ___________________ FAX: ______________________

Email Address: _________________________________________________
**we will send your account settings to this address**

Your signature indicates:
 Acceptance of the "netINS Hosting Terms and Conditions" (below) -- Agreement to pay for service beginning on the day your account settings are provided to you -- If you have netINS register your domain name signature also signifies that you've agreed to the domain registration terms available at http://webhosting.netins.net/domainreg/exhibita.html.

Signature: __________________________________________ Date: ___________
A Signature is REQUIRED.

BILLING CONTACT: (if different) If bills for your netINS Hosting account and/or bills for the domain name should not be sent to the person listed in the above section, list the person that bills should be sent to here. This should be a person, not a department.

Name:_____________________________________________________

Organization: _________________________________________________

Address: _____________________________________________________

City/State/Zip:_____________________________________________________

Daytime Telephone: _________________ FAX: _____________________

Email Address:_____________________________________________________

PAYMENT INFORMATION: Select the level of netINS Hosting service you've decided on here:

Standard Servers
[   ] netINS Standard Web Hosting - Monthly Charge: $12.99 (150MB, 10 email accounts*)
[   ] Additional Space (75MB) - Monthly Charge: $10.00

Premium Servers
[   ] netINS Business 1 Web Hosting - Monthly Charge: $14.99 (500MB, 20 email accounts*)
[   ] netINS Business 2 Web Hosting - Monthly Charge: $16.99 (500MB, 20 email accounts*)
[   ] netINS Business 3 Web Hosting - Monthly Charge: $19.99 (750MB, 20 email accounts*)
[   ] netINS Advanced 1 Web Hosting - Monthly Charge: $26.99 (1 GB, 30 email accounts*)
[   ] netINS Advanced 2 Web Hosting - Monthly Charge: $39.99 (2 GB, 40 email accounts*)
[   ] netINS Advanced 3 Web Hosting - Monthly Charge: $69.99 (7GB, 60 email accounts*)
[   ] netINS Advanced 4 Web Hosting - Monthly Charge: $199.99 (10GB, 300 email accounts*)
[   ] Additional Space (50MB) - Monthly Charge: $10.00

Mail Hosting
[  ] Email Hosting Only - $8.99/month (10 email accounts*)

* Billing for netINS Hosting email accounts is based on the maximum number of users you have added to the system at any one time over the course of a month. In the event that you add no more email addresses than the number allowed, you will be billed for the price listed above. If you add additional accounts above the allotted amount your account will be billed $2.00 per month for each additional account. An invoice detailing the largest amount of users you had activated for the billing period will be issued monthly.

Bill me: [   ]   or  Credit Card: [   ]                Card Type:   VISA [   ]     MasterCard [   ]

Card Holder Name:___________________________________________________________
Card Number:________________________________________Exp. (Month/Year):______
Card Holder Address:________________________________________________________
________________________________________________________
City/St/Zip:__________________________________________________________
Daytime Phone Number:(____) ____ - ______

CARDHOLDER Signature:________________________________________
Note: Your signature authorizes netINS to process a charge against your credit card at the end of a normal billing period.


ACCOUNT CONFIGURATION INFORMATION: Enter the domain name for your netINS Hosting site in the server name blank. Some examples of domian names are: iastate.edu, apple.com, and netins.net

Server/Domain Name: ________________________________

I need netINS to register my new domain name: Yes: ___ No: ___

How many years would you like to register your domain for? (Place an X in the box to the right of the term you would like to have netINS register your domain for)

1 Year $20.00

 

2 Years $40.00

  3 Years $44.85  

If your domain name is already registered, would you like to have it transferred to netINS control? Yes: ___ No: ___

netINS, Inc. will charge you for use of a domain name registered in the ".com", ".org", or ".net" top level domains on your first bill. Renewal notices will be sent to your administrative contact email address near the end of the term you have selected. Prices subject to change. For more information about netINS domain registration visit http://webhosting.netins.net/domainreg/. To check if the domain you want is available visit http://webhosting.netins.net/domainreg/cgi-bin/form.html

Email: netINS Hosting provides at least 5 total email addresses using your domain name. You can set up your email accounts on an administrative web site that we'll provide for you. You'll be able to use the username and password we provide to you to gain access to the site and administrate your users.

If you choose, we can point all mail for your domain name at a different mail server (possibly one that you operate in your office). If you have a mail server that you would like us to forward your email to please name it here:

___________________________________________
(mailserver.yourdomain.com)

Please MAIL or FAX application to: netINS, Inc. Attn: Webmaster
312 8th St., Suite 400
Des Moines, IA 50309

Fax: (515) 830-0345
Voice: (800) 205-1110
Email: webmaster@netins.net

netINS Internal Use Only Customer No: ____________________ Date Processed: _______


netINS Hosting Terms and Conditions

1. By signing this registration form and agreement, you (customer) agree to the following terms and conditions of the service described below.
2. These services are provided by netINS, Inc., 4201 Corporate Drive, West Des Moines, IA 50266-5906.
3. Technical support is available upon activation of your account.
4. All charges will be billed on your approved credit card as described on the netINS Hosting Registration Form. If for any reason a posting to your credit card is not accepted your service may be discontinued. An additional registration fee as well as re-establishment of valid credit will be required to re-establish service.
5. netINS, Inc. makes no express or implied warranty of any kind. There is no express or implied warranty of merchantability or fitness for a particular purpose for the services to be provided by netINS. netINS makes no attempt to verify accurate receipt of any message and is not responsible for any loss of data resulting from delays, nondeliveries, incorrect deliveries or service interruptions, including those caused by negligence, errors, or omissions of netINS, nor for consequential damages regardless of their cause.
6. Customer agrees to comply with the terms governing use of the netINS network, as they may change from time to time. Any changes to the terms governing use of the netINS network will be posted as warranted on the netINS computer system. http://www.netins.net/policy/
7. This agreement shall be governed by and construed in accordance with the laws of the state of Iowa applicable to the contracts to be performed entirely within the state.
8. Either party may terminate this agreement at any given time by giving written notice. Such notice is effective when given. Customer is obligated to pay for service through the termination date as detailed on the final invoice.
9. By accessing and using the netINS computer system, user is consenting to system monitoring for law enforcement and other purposes. Unauthorized use of or access to this computer system may subject users to criminal prosecution and penalties. User agrees to indemnify netINS against liability for any and all use of user's account.
10. netINS reserves the right to refuse placing materials in this account which may be deemed by netINS to be offensive to potential readers, or which may be contrary to state and federal statutes. netINS reserves the right to discontinue providing this service on your behalf for any cause deemed sufficient by netINS.
11. By signing this agreement, you agree to absolve netINS of any liability for the content and distribution of materials placed in your area by yourself or any other persons or entities. Any questions or disputes which arise in this regard must be corresponded in writing to representatives of netINS.