Edifax Internet Services Website Hosting, Dilaup Accounts, Domain Registration
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Web Hosting Registration Form

EDIFAX hosting has all the extras built in as a part of the basic service! This includes the Parallels Pro Control Panel which provides our clients with unprecedented control over their accounts. Give us a call today at (757) 484 1400 if you have any questions.

You can use this form to register for a web hosting account online! Please read the Web Client Agreement and fill out the form making sure to include the required information and checking the last item. When you submit the form, we will contact you within 24-48 hours.


NOTE: Items marked with a red asterisk ( * ) are required to be filled in.


Business Information
Are you a current EDIFAX client? No Yes
Your Name *
Company Name
Street Address
City
State
Zipcode
Phone (Area Code First) *
Email Address
How did you find us?
Account Information

Desired account name *

This is required even if you are getting your own domain name! The account name is the name you will use to access the web server for changing your page, retrieving email, etc.
Password * This is the password you'll use to upload files, check email, and generally access all your account's feature.  Some proper passwords would be Monkey27, Gat0rs, or 1147Gold. Remember, be careful choosing your password, if someone else guesses it, they have full access to all your files and email!
Account type
Basic Web Services Package $14.95/month
Web Services Package and Unlimited Internet Dailup $23.95/month
Domain Information

Domain Name 

Domain names are limited to 67 characters, using a-z and - only. The - cannot be the first or last character. Remember, if abc.com is taken, so is www.abc.com, and the same entity owns anything.abc.com.

This Domain Name is

New 
Already Registered thru EDIFAX
Being transferred

If you're moving your web site from another server and already have a domain name registered that you would like to use on our servers, check "Being transferred"
 Email Accounts

Number of Email Accounts

  Email accounts in addition to the 10 that comes with your account. $1 each per month.
In this box, please list the email names you'd like for all your email accounts and the password for each account. These names will receive and send email under your domain name.
Special Instructions
Special Instructions
 or Requests
Payment Information
Method Credit Card Select your payment method. If you select check or money order, your application will be held for processing until your payment arrives. Checks are limited to US banks. Only credit cards are eligible for monthly payment. All payments must be in U.S. funds. Please send Check/Money Orders to:
EDIFAX, PO BOX 8212, Norfolk, VA 23503
Check 
Card Number
Expiration date
Exact name on card
Payment term Monthly  Select a payment term. For credit card payments, we will charge your card for the remainder of the month/quarter.  Semi-annual and annual payments are in full. You will be invoiced each 6 or 12 months.
Semi-annual
Annual

Please check here to acknowledge that you have read and agree to the standard Web Client Agreement.

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