Signup Online

Online Activation Form

To become a Nebulis Associate, please fill out the fields below.

New Application Modify Existing Account/Nebulis ID:

Personal Information

Applicant's Name
Business Name (DBA, if applicable)
Billing Address
Address 2
City
State or Province
Zip/Postal Code
Country
Phone #1
Phone #2 (optional)
Fax (optional)
Social Security or Tax ID Number
E-Mail

Account Setup Information

Select Account Type	Net-Pack+ - $39.95/monthly
	Pro Networkers Lead Pack - $45.00/monthly
	Pro Networkers Support Pack 1 - $110.00/monthly
	Pro-Networkers Support Pack 2 - $160.00/monthly

Account Activation Fee	$35.00 one time setup fee

Send Leads Via (Pro Networkers Services Only)	E-Mail Snail Mail
Primary Program (for lead tracking only)

Choose a username and password to access Nebulis Networks. Your username will be part of your assigned e-mail address (e.g. username@nebulis.net) as well as your login identification when you connect to Nebulis Networks. Usernames can be a maximum of 12 lowercase letters and digits. Passwords must be 4 to 8 letters and digits and is case-sensitive. We recommend adding a number to all passwords.
Username
Password
Confirm Password

All NEBULiS hosting accounts are available with your own Domain Name (www.yourname.com) or with a NEBULiS sub-domain (www.yourname.nebulis.net). Network Solutions charges $35.00 per year to register and hold a domain name. Once you register a domain it is your to keep as long as you maintain the registration with Network Solutions. There is no additional charge for transfers or for NEBULiS sub-domains Please select one of the following options:

A	New Domain Transfer Existing Domain Domain Name http://www.
B	NEBULiS Sub-Domain Domain Name http://www..nebulis.net

Payment Information

Credit Card Type
Credit Card Number
Credit Card Expiration Date
Name On Card
For security reasons, the billing address to the above listed card must be identical to the address listed above.
By submitting this form I agree to purchase the services requested above and authorize Nebulis Networks to draft my monthly service fees from my credit card. Once charged all services are nonrefundable.

Please check the information you have entered. If it's correct, then we're ready to process your registration. Click “I Agree, Submit This Form” to complete your registration. If you'd like to clear the information you entered and start over, click the Clear Form button.

Nebulis Networks International • 3592 Corporate Dr. • Columbus, OH 43231
(614) 508-1150 Phone • (614) 508-1159 Fax