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Pay Annual Fees by Check

All Fields Required

Account Information:

Your Name:
E-Mail Address:
Your response will be sent here. Please insure that your spam blocks are setup to receive email from client.services@therealestatehost.com, or it is possible that our response to you will be sent to your spam folder therefore, you will not receive our response.
E-Mail Address Again:

Domain Name:
Hosting Fee Due:
Enter amount shown on email for hosting fee.
Amount after any discounts.
Registration Fee Due:
Enter amount shown on email for registration fee.
If no registration enter 0.00.


Checking Account Information:
(enter information just as it is on your check)

Name On Check:
Address 1:
Address 2:
City:
State:
ZIP Code:
Country: (US Only)
Phone Number on Check:
(Include Area Code)
Bank Name:
Bank City:
Bank State:
Bank Zip Code:
Bank Phone Number:
Bank Routing Number:
This is the first set of numbers on the bottom of your check between these symbols: ######## (if you are unsure, contact your bank.)
Checking Account Number:
This is the second set of numbers on the bottom of your check located just before this symbol:
Drivers License Number:
State Where Issued:
Date of Birth:

AUTO RENEWAL INQUIRY:
Would you like for us to set your hosting fees and if applicapable, your registration renewal up for auto renewal each year hereafter? By selecting yes we will automatically renew your hosting fees and registration (if applicable) and bill the above provided checking account each year 1 week prior to your actual renewal date. This will insure your uptime and prevent loss of domain registration should you miss the email notices sent.

Auto Renewal:


            POLICIES & CLIENT AGREEMENT:

            All clients must agree to the following policies before continuing. If you do not agree, do not continue.


           BULK REGISTER / ICANN REGISTRATION AGREEMENTS: (view in separate window)


  
I Agree To And Understand That I Am Bound By The Above Policies as Outlined By Bulk Register LLC and ICANN.

           THE REAL ESTATE HOST REGISTRATION AGREEMENT: (view in separate window)


  
I Agree To And Understand That I Am Bound By The Above Domain Registration Agreement as Outlined By The Real Estate Host.

          THE REAL ESTATE HOST TERMS OF SERVICE & USE POLICIES: (view in separate window)


  
I Agree To And Understand That I Am Bound By The Above Terms of Service and Use Policies as Outlined By The Real Estate Host.

Please review this form for accuracy before submitting. For security purposes, your remote address and user agent are traced through submission.

By submitting this form you confirm that you are the authorized user of the above checking account and authorize The Real Estate Host / BLUEINKIT.COM to debit your bank account for your annual fees as indicated above.

NOTE: BLUEINKIT.COM will be the name that will appear on your credit card/banking statement.

NOTICE: Returned checks, whether due to insufficient funds, incorrect checking account number, or other reason provided by your banking facility, will result in immediate account suspension without notice to you and will incur a $25.00 return check fee in addition to service fees due prior to account reactivation.



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