Note: Please provide us with the required extra documents at your earliest convenience to ensure that your account with TechHaus Host is setup as soon as possible. We apologize for any inconveniences this process may cause. Please don't hesitate to contact us if you have any questions, comments, or concerns. We are more than willing to help.

Please provide this information in your email:

Hello,

I want to sign up with TechHaus Host.

I am providing the information below, so you can create a new billing account for me.

--- Personal Information: ---

First Name:
Last Name:
Secondary Contact:
Email:
Secondary Email:
Company:
Address 1:
Address 2:
City:
State/Region:
Zip:
Country:
Phone:
Fax:

--- Account Information: ---

Plan Type (Private Starter, Business Complete - Silver, etc):
Username:
Password:
Domain Name:
Do you want us to register this domain (Yes/No):
Do you agree to our TOS (Yes/No):
( You may view these at TechHausHost - terms_of_service )

--- Payment Information: ---

Payment Method (Credit Card, PayPal, Money Order, Western Union):
Billing Cycle (Monthly, Yearly, Quarterly):

In order to proceed to setup my account, I understand I will need to confirm my information. I am including a scanned copy of a government-issued Photo ID such as as a passport or driver's license. In addition, I am including a scanned copy of the credit card that will be used in the purchase, (with option to mask the first 12 digits for security). If I am not paying with credit card, I will provide a copy of a current utility bill that shows my name and address.