Web Hosting Order Submission

Choose your Figment User ID:
	(examples: "johnsmith" or "george5")
Password:
Re-type Password:

Choosing your ID You will use this information to access your Figment hosting service. Remember, capitalization matters as passwords are upper and lower case sensitive!

If you forget your password, we would identify you with this information:

Security Question:
Your Answer:
Alternate Email:

Recalling your password This is our only way to verify your identity. To protect your account, make sure "your answer" is memorable for you but hard for others to guess!

First Name:		Last Name:
Company:
Street Address:

City:
Province:
Postal Code:
Country:

Primary Phone:
Alternate Phone:
FAX:

Contact Information:
This will help us get in touch with you should email not be available.

Service Package:
Domain:
Domain Registration:	for
Title of Site:
Brief Description:

Language & Content:
Any additional Comments or Notes:

Domain Information:
This will provide us with the necessary information to get your website up and running fast!

Include my site in the Figment website directory listing and for Search Engines.

By submitting your registration information, you indicate that you agree to the Figment Terms of Service and have read and understand the Figment Privacy Policy. Figment enforces a strict zero tolerance policy against unsolicited commercial email by utilizing email message content filters, DNS block/access lists, firewalls, and random manual inspections which may potentially affect legitimate email. Please report any disruption of legitimate email to Figment for investigation and corrective measures.

Your submission of this form will constitute your consent to the collection and use of this information and the transfer of this information to Canada for processing and storage by Figment. You also agree to receive required administrative and legal notices as required by Figment electronically.

All information is held in strict confidence and will not be sold, traded, or otherwise distributed without the express consent of the provider except where required in the normal delivery and operation of services ordered.