Pacific Internet - Ukiah, California

Dial-up & Hosting Sign-up Form

Dial-up & Hosting Sign-up Form

(click to verify)

To sign up for DSL service, please click here.

If you are signing up for a dial-up connection, please check our Local Dialup Access Numbers to make sure your city is part of our coverage area.

If you have trouble choosing the correct options, or you are unsure, just skip that section and we will contact you for the additional information.


Account Information

Your Name:
Address 1:
Address 2:
City:
State:
ZIP:
Daytime Phone:
Email Address:
Operating System:
Username:
Hosting username may not be the same as the domain name.
Alt. Username:
Alternate username used if first choice is unavailable.
Password:
Minimum length of 8 characters.
Must contain letters, numbers, & symbols.
Can not contain the username.

Type of Service

Type of Service:
Full Descriptions & Pricing.
If you selected a hosting package above, please tell us the domain name you will be hosting.
Domain name registration is available here
Domain Name:

Payment Information

Please select one of the following billing options: Bill my credit card automatically monthly.
Bill my credit card automatically quarterly.
Bill my credit card for just this quarter.
Bill my credit card for 1 year (20% savings).
Credit Card Type:
Credit Card Number:
Expiration Date: /

Please check the following box before you proceed.
I have read and agree to the Pacific.Net Acceptable Use & Tech Support Policy


Note: 20% discount for annual billing does not apply to Starter Hosting.