Create A Web Hosting Subscription | BrainScanMedia.com, Inc

Hosting Subscription Signup

Looking to set up a fresh private web hosting account for the website recently constructed by BrainScanMedia.com, Inc.? You're in luck! Simply complete the form below to submit your account creation request to us. Upon receipt and processing of your request, we will promptly inform you when your account is prepared. Please allow for a response time of up to 24 hours. Please be aware that your credit card will not be charged until your account setup is complete.

Hosting Package

Select Hosting Package

Select Billing Duration

Enter Domain Name To Be Hosted: YourDomainName.com

Private DNS Panel Access (+$3.00/Mo) (Control your own DNS records & mail forwarding addresses.)

Total Cost: $0.00

Email Address Setup

Email Option

At this time, we do not provide email account services directly. All email accounts are established through an external email service, which is distinct from BSM and involves separate billing. If you wish to use your own service, please indicate your preference in the dropdown menu above.

Email Forwarding List

Enter Emails Addresses Here...

Please provide a list of the email addresses you would like to set up based on the setup type you selected above. Please list each email address on a separate line. If you require forwarding, please list email address and forwarding address. Example: name@yourdomain.com > name@gmail.com

Payment Information

Credit Card Number

Expiration Date (MM/YYYY)

Security Code

Billing Information

Company Name (Optional)

First Name

Last Name

Phone Number

Email Address

Street Address

Apt, Suite, Etc (Optional)

City

State

Zip

Referred By (Optional)

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