On-line Registration Form
Name:
Company Name:
Address:
City:
State
Zip Code
Phone Number (area code first)
Fax Number (area code first)
Referred By
Operating System
Amount Received
$
What type of account best fits your needs?
Personal account (for personal use only)
Family account (for personal use only)
Business (with web pages)
Domain (no dialup connection)
Domain (with one dialup connection)
Domain (with two dialup connections)
Domain (with two dialup connections and web page updates)
Username (5-8 characters):
Please note:
Usernames are always lower case. The username is the name you will use to log in.
It is also your email address (Example: username@treknet.net)
Password (5-8 characters):
Please note:
Passwords are case sensitive. (Example: Tom is not the same as tom or TOM)
For more security, please use a combination of letters and numbers for passwords.
Domain name: http://
Please
check here
to make sure your domain is available. Domains are registered by a third party company.
TrekNet does not guarantee the availability of any domain name.
Card Type:
Visa
Mastercard
American Express
Discover
Card Number
Expiration Date
Name on Card
I would like my card charged
Monthly
One time start up charge only
Amount to be charged $
First month and set up fee required for account to be set up.
Contact Person's Email
Contact person is the person to send a reply to verifying the account has been set up if applicable.
Please enter any comments or questions that you may have below:
I have read and agree to the rules and regulations on TrekNet's
User Agreement