Miditech Order Form

Miditech.com and AtomicNorth.com are owned and operated by YourHostNetwork.com Inc.

	519-266-3434 (M-F 9am-5pm EST)
	Serving the web community since 1996.

Ordering Web Hosting

Thank you for choosing Miditech / AtomicNorth and for placing your trust in our services. We have been offering hosting service since 1996 and we welcome as a valued customer. Once the order has been submitted, a representative will contact you on a next day basis, Mon-Fri, 9am-5pm EST to review your order and help you with anything else you may require. We want to make sure that you receive the service that you deserve and we want to be sure to help you in any way we can.

DOMAIN NAME REGISTRATION	.com /.net/.org/.ca and many more...

OPTION ONE:
I Want To Register A New Domain Name:	Domain Registration is handled via our Domain Name Registration Division (DomainNetAve.com). To register a new domain name please click here and our Domain Registration services website will open. Search and Register the domain name and then return to this Hosting Plan Order form to continue ordering. Once registered go to Option 2. This ensures that you have complete access to your registered domain(s) and that all ICANN policies and rules are strictly followed which is in the best interest of our customers.
OPTION TWO:
I Already Registered A Domain Name:	If you already have a domain name registered, please enter it in the field below. We will inform you of the name servers once the host plan has been setup for you on our servers. Additional Domain Names can be added via the Host Control Panel after signup.
	Domain Name Registered:
	(Please include the extension (.com/.net./ca./ etc)
	Note: A hosting account requires at least one domain name be associated.

CUSTOMER ACCOUNT
First Name:
Last Name:
Email Address:
	! IMPORTANT: Do not use an email address based on the domain name that you will be hosting with us. This should be an email address outside of our hosting system, such as a hotmail or gmail or any other non hosted email address. This is the email address all correspondence and Invoices will be emailed to.

Address 1:
Address 2:
City:
Province/State:
Pleace specify:
Postal/Zip Code:
Phone Number With Area Code:
Mobile (optional):

Referal ID (if you have one):

HOST PLAN DETAILS
Hosting Plan:
	Notes: - VPS OPTIONS will be discussed with the client prior to the setup of the VPS. - VPS plans can take up to 48 hours to setup.

Billing Cycle:
	* Discounted monthly rates on 12 and 24 month plans. Minimize this order form for details.

ADD ONS:
Dedicated IP:	Add a dedicated IP to my Domain (Add $3.00/month)
	Note: A dedicated IP is a scarce resource. As such there must be a valid reason for having a dedicated, usually to facilitate a SSL Security certificate for encryption of data, such as accepting credit cards or personal information.

AGREEMENTS:

By submitting the order below you are stating that you agree to our current Terms and Conditions Of Service (TOS) policy as well as all other policies as shown on our website at http://miditech.com/policies.html . Once your order has been placed a Miditech / AtomicNorth representative will contact you to answer any questions you may have as well as collect payment information. You should hear from us within 24-48 hours during our normal hours of operation which are Mon-Fri., 9am-5pm EST.


	13% HST will be added for Canadian Residents.