Thank you for your interest in ordering from HyperHosting! Please print out this form and mail it to:

HyperHosting, LLC. 570 West 78th St. #2001 Chanhassen, MN 55317-9676

Domain Name: ______________________________________

User Name: The user name will be the same as the domain minus the extension.

Requested Domain Package: Standard - Professional - Developer

Contract Length in Months: 1 - 3 - 6 - 12 (Please circle one)

Comments: _______________________________________________________________

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Full Name: _________________________________________

Company: __________________________________________

Address: ___________________________________________

City, State, Zip: _____________________________________

Country: ___________________________________________

Phone: _____________________________________________

Fax: _______________________________________________

E-mail: _____________________________________________

Additional E-Mail Address: _____________________________

Company: __________________________________________

Payment Type: ______________________________________ (Credit Card, Check, Etc.)

Please fill out the following if you are going to pay by credit card. If you are paying by check you can say that in the blank above and skip the rest of these steps.

Credit Card Type: Visa - Mastercard - Discover (Please circle one if paying by credit card)

Name on Credit Card: _________________________________

Card Number: ________________________________________

Expiration Date: ______________________________________

Please notify us by email after you have mailed this to us. Thank you.