Panix Web Service Order Form

Please do not fill out this form until you are ready to place an order. Submission of this form is an agreement to purchase the indicated Panix service, and you will be billed accordingly.

If you have chosen 'Normal DNS service' for the DNS service level (that is, you wish Panix to provide DNS service for this domain), and this domain already exists in the global DNS system, we must verify that you control this domain. We will add the service, but DNS for the domain will not be served until such verification has taken place. There are 2 ways to prove control of the domain:

• Update DNS settings at the domain registrar to point to
  • ns1.access.net
  • ns2.access.net
• Add a TXT record at the top level of the domain at the current DNS provider with the content 'movingtopanix'.

Once this is done, a nightly job will update the verification state of the domain. You can speed the process by clicking the Recheck button in the DNS control panel at https://config.panix.com/dns once we have processed your order.

If you have questions, or would like further clarification, please send us email.

Service information

* Domain name		Please do not include 'www.' in the domain name. It will be removed if you do. Information on creating or updating your domain registration can be found at http://www.panix.com/help/registrar.html.
* Service level	Basic packages Cheap Web Addons (existing Basic package required) Multi-domain Cheap-web	If you do not see the service you are looking for, please contact us. About multi-domain addons Multi-domain web service is an additional domain pointed at a site you already have hosted at Panix.
Billing period	monthly quarterly yearly	The billing period you select will apply to mailboxes in this domain as well.
Mail service		All Panix web services include mail service for the domain. Uncheck if mail for this domain is to be handled elsewhere.
Mailbox billing	Individual Block	Mailboxes can be billed individually, or in blocks of 10. Click here for pricing information.
DNS service	Normal DNS service Slave DNS is hosted elsewhere	If you have chosen normal DNS, we will automatically set up records necessary for Panix mail service. You will be able to add and manage additional records using our control panel at config.panix.com/dns. If you have chosen slave service, you will be able to set up the Masters at config.panix.com/dns.
* Masters	At least one master is required for slave DNS
* Masters	At least one master is required for slave DNS
* Maintenance account	Add a new shell account Use an existing shell account	A maintenance account is a panix shell, which you will use to access your web space. If you choose to use an existing shell, we will upgrade that shell to the service level you have chosen.

Please give us support contact information for this account

Use my billing contact information
* Name
* Phone 1		Non-US numbers should begin with a '+'
Phone 2
* Email address
When is a good time to call? (please note your time zone)
Additional info

Do we need your billing information?

Please add this to my current bill (you will be asked to authenticate) New billing record supplied here
Company
* Name
* Street address
* City		* State	AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY non-US
* Country	Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kosovo Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands	* Postal code
* Phone 1		Non-US numbers should begin with a '+'
Phone 2
* Email address
Please enter a challenge and response we can use to verify your identity over the phone. For example:
Challenge	What was the first school you attended?
Response	Springfield Elementary
* Challenge
* Response
Reset email address		Optional: an email address to use for password reset email if you've forgotten your password.

*  indicates required field