Order Gryphon Web Hosting

To order hosting, please complete the form below. Your account will be enabled as soon as payment is received and verified. You will receive your IP address, username, password, and quick-start welcome letter via email within an hour of payment verification.

Name (First, Middle, Last)

Company

Street Address

Address (cont.)

City

State / Province

Zip Code

Country

Work Phone

Home Phone

FAX

E-mail (offsite)

Existing Web Address (if applicable)

Selected Plan

Billing Frequency

Choose a User Name*: (maximum 8 characters)

*The user name must start with alpha characters and consist of lower case alpha characters, numeric characters, the minus sign "-" or underline "_".

Please do not change the following section unless you would like to fill in specific Contact information for the InterNIC registration.

Use the information above for the Administrative Contact information.

Use the information above for the Billing Contact information.

Have us be your Technical Contact.

What is (or will be) your domain name? We can host ANY domain name extension.	www.
This is a new domain. We can register/buy any available .com, .net, or .org Please select the number of years for which you would like your domain registered ($25/year - save $10!).
I already own this domain name

Choose Method

If paying by check, send payment to:
Gryphon Media
178 Peacehaven Rd.
Winston-Salem, NC 27104

Your site will be enabled upon receipt and clearance of payment. If paying by check, please allow 7 to 10 business days for clearance.

Name (First, Middle, Last)
Company
Street Address
Address (cont.)
City
State / Province
Zip Code
Country
Work Phone
Home Phone
FAX
E-mail (offsite)
Existing Web Address (if applicable)

*Choose a User Name:**	(maximum 8 characters)
*The user name must start with alpha characters and consist of lower case alpha characters, numeric characters, the minus sign "-" or underline "_".

Please do not change the following section unless you would like to fill in specific Contact information for the InterNIC registration.
Use the information above for the Administrative Contact information.
Use the information above for the Billing Contact information.
Have us be your Technical Contact.

Choose Method
If paying by check, send payment to: Gryphon Media 178 Peacehaven Rd. Winston-Salem, NC 27104	Your site will be enabled upon receipt and clearance of payment. If paying by check, please allow 7 to 10 business days for clearance.

Copyright © 2001 Gryphon Media. All rights reserved. Revised: January 12, 2005

Copyright © 2001 Gryphon Media. All rights reserved.
Revised: January 12, 2005