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If you already have an account with eVerity it is not necessary to fill out this form.
Simply contact your account manager to be upgraded to reseller status.

Contact Information
First Name:  
Last Name:  
Company Name:  
Address 1:  
Address 2: (if needed)
State / Province:  
Zip Code:  
Fax: (optional)
Email: IMPORTANT: Urgent notices and sensitive information may, at times, be sent here. Please use an email address that you check frequently.
Plan Selection
Res-1 $9.99, 3 Gigabytes disk space, 30 Gigs of transfer, Unlimited domains
Res-2 $14.99, 10 Gigabytes disk space, 100 Gigs of transfer, Unlimited domains
Res-3 $24.99, 20 Gigabytes disk space, 200 Gigs of transfer, Unlimited domains
Res-4 $34.99, 30 Gigabytes disk space, 300 Gigs of transfer, Unlimited domains
Res-5 $54.99, 40 Gigabytes disk space, 400 Gigs of transfer, Unlimited domains
Res-6 $64.99, 50 Gigabytes disk space, 500 Gigs of transfer, Unlimited domains
Master Domain & DNS Name Servers
Master Domain: This is the main domain name you will be using for your reseller account. (i.e. your business website address)
Primary Nameserver: Please supply the name of the name servers you wish to have set up for your usage. We suggest using NS1.MASTERDOMAIN.COM and NS2.MASTERDOMAIN.COM, where "masterdomain.com" is the master domain you selected above.
Secondary Nameserver:
Additional Options
2 IP's (free)  
Do not install siteZen siteZen is a powerful site creation tool. When enabled, your hosting customers will be able to build their own web sites quickly and easily.
Yes, please install siteZen
($10.00 /month for unlimited usage)
Reseller Username & Password
Username: 6 - 8 characters, all lowercase
Password: should consist of numbers and letters, with mixed upper and lower cases, not based on dictionary words.
Payment Information
Card Number: 
Expiration Date: 
Card Code:  A 3 or 4 digit number, not in raised lettering.
On Visa, MasterCard, and Discover it is on the back.
On American Express, it is on the front.
I have read, understand, and agree to abide by eVerity's Terms of Service.
I understand that I am responsible for preventing my resold accounts from sending spam, and for ensuring my resold accounts do not violate eVerity's content and usage guidelines.
Questions / Special Instructions
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