E-Commerce Order Form
(Secure Order Form)

If you have any questions please call toll free 1.877.ESCAPE.NET -or- 1.800.985.HOST.
or 212-888-8780 (NYC residents) or e-mail info@escape.com.

Subscriber Information

  First Name
  		Last Name
 Address (Line 1)
  Company or Organization Name
   (if not applicable your name)
  		Address (Line 2)
  Phone
  --		 City  
  Fax
  --		 State/Prov.       ZIP
,
  E-mail Address
  		Country

Account Information
Domain Name
www.[r_domain]
Username  
Password (max. 16 characters)
Promotional Code (optional)
Payment Plan

The Monthly Plan is $40.00 per month (plus $30.00 start-up fee), a total of $480.00 for one year of service.  Our One Year Special is a pre-paid plan in which you receive a 20% discount (waived start-up fee).  Total of $384.00 for the year, only $34.00 per month.

Check here if this account will require   
      Microsoft FrontPage Extensions.  

 Additional Information


Where did you hear about Escape.net?


Method of Contact

E-mail     Telephone     Fax   

 

IMPORTANT AGREEMENT:

THERE IS NO REFUND FOR DOMAIN REGISTRY. ONCE ORDERED THE DOMAIN BELONGS TO YOU.

The cost to register a domain with Kazan Corporation is $15 for the first year, and $15 for each year following. This payment will be billed to you, the subscriber by Kazan Corporation / Escape.com. By applying for the domain name and through the use or continued use of the domain name, the applicant agrees to be bound by the terms of ICANN's and TUCOWS registry current domain name policy which is available at:
http://www2.escape.com/agree/udrp.html http://www2.escape.com/agree/agreement.html

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