Internet Starter Plan Order Form and Domain Registration and Web Site Design in Costa Rica, Central America

Internet Starter Plan Order Form

Part 1 - Your Web Site Domain Name

A domain which ends with .com, .net or .org can be registered within one day and is included FREE with your Internet Starter Plan.

We can host domains with other extensions, but you are responsible for contacting the NIC (registrar) in the respective country to complete the registration for other countries.

You may check the availability of the domain name Check Domain.

Domain Name:

Please indicate how you wish to process your domain name:

New Domain.
We will automatically register your domain for you.
Transfer existing domain from NETWORK SOLUTIONS.
We will automatically start the transfer process for you.
I will handle my Registration/Transfer.
(If you registered your domain with a registrar besides Network Solutions, you must contact them to transfer your domain after you have ordered the hosting plan.)

Part 2 - Your Web Site Account

Your User Name must start with a letter, but can contain numbers. The length of User Name should be no more than 8 characters. For instance, if you have test123.com, you may wish to use test123 as your username.

User Name:

Part 3 - Web Site Company Owner

NAME (First,Last):

Company:

Address:

City,State,Zip:

Country

State(other):

Telephone:

Enter your email address. Note: We use your email address to verify the order process.

Email

Part 4 - Domain Contact Information

Please do not change this section unless you would like to fill in specific Contact information for the domain registration. You may also uncheck if you know your NIC handle and want to use it.

Use the information above for the Administrative Contact information.
Use the information above for the Billing Contact information.
Have AccesoYA.Net be your Technical Contact.

Part 5 - Your Web Site Design

Please review the following web site designs and then make a selection

Design 1

Design 2

Design 3

Design 4

Design 5

Design 6

Design 7

Design 8

Site Design:

Part 6 - Payment Selection

Credit Card.
Company Check.
Bank Deposit.

Your payment information will be send via our Secure Server to ensure its confidentiality.

If you selected the Credit Card Option, you will be billed on a quarterly basis $62.49 and will need to include the following information:

Card Type:

Name On Card:

Card Number:
e.g., 4123-4567-8910-1234

Expiration Date: /

If you selected the payment options of Company Check or Bank Deposit we will contact you via your Email account to process your payment.

You will receive a confirmation letter via Email where you will receive instructions for sending us information for your web site design: company text, photos, etc.

By submitting this order, you agree to our Terms of Service.