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Create an Account  

Note: all required fields have a red star *.

Login Information
* Username : 

( min 4 max 20 chars. alphanumeric )
* Password : 
( min 4 max 20 chars. alphanumeric )
* Re-type Password : 
( min 4 max 20 chars. alphanumeric )
* Secret Question : 
* Secret Answer : 
( Used for account verification and password retrieval )
Account Options
Notify me when my account balance falls below   $

Stay up to date with our mailing list subscription

Note: Seguin Host reserves the right to contact members in urgent matters.

Contact Information
* First Name : 
* Last Name : 
Organization Name : 
Job Title : 
* Email Address : 
Secondary email address : 
* Address1 : 
Address2 : 
* City : 
Please, select one

* US State  

* Province  

* Not Applicable  

(the state/province field will be left blank)
* Postal/ZIP Code : 
* Country : 
* Country Phone Code : 
* Phone : 
(numbers only, no dashes or dots)
Fax : 
(numbers only, no dashes or dots)
Domain Registration Contact Info
Please fill out the information accurately.
This information will be used for your domain registrations.
ICANN reserves the right to disable domain names with invalid contact information

  Use the following information for domain contacts.

Check this checkbox to re-use/copy info entered above for Contact Info

* First Name : 
* Last Name : 
* Email Address : 
* Address1 : 
Address2 : 
* City : 
Please, select one

* US State  

* Province  

* Not Applicable  

(the state/province field will be left blank)
* Postal/ZIP Code : 
* Country : 
* Country Phone Code : 
* Phone : 
(numbers only, no dashes or dots)
If applicable, fill out all three fields below. If not applicable, leave them all blank
All three must be entered or all three must be blank
Organization Name : 
Job Title : 
* Required if ORGANIZATION entered
Fax : 
* Required if ORGANIZATION entered
(numbers only, no dashes or dots)
Set default nameservers for all domain registrations below.
If you are unsure or would like to use our default nameservers, leave the fields blank.

Nameserver 1 : 
Nameserver 2 : 
Nameserver 3 : 
Nameserver 4 : 
Additional Information
Comments : 
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