Please give us you contact information below.  The form must be filled out completely so that we are able to contact you if needed.  We also need to know a username and password to setup on your Ventrilo server, so that information will need to be provided as well.  You can change your password after your first login to the server.  After we have received your information we will send an e-mail to the address you have provided with an account number as well as a total amount to begin your server.  This amount will be your first partial month and your first full month of service, there after you will be billed monthly. 

Please provide the following contact information: 

First Name
Last Name
Title i.e Founder, Owner
Organization i.e home or clan name
Contact Number Format: 800-555-1212
Contact E-mail
URL If your clan or organization has a website

Please provide your account information:

User Name This will be the default username for your account, Please note that to login to the control panel you will have to the e-mail address provided above.
Password Please make this password at least 6 characters long
Confirm Password Please repeat the password

Where would you like your server located?

Choose one of the following options:


Number of slots required?

Choose one of the following options:




Payment Options

As of right now we are only accepting PayPal for payments so that we can keep our costs down.  We will send an e-mail reminding you of your payment if it has not been received by the second of the month and will suspend the server usage if not received by the 5th of the month.  If we do not receive payment after the 10th of the month we will stop the server, should you choose to begin using it again we will charge a 10.00 reconnect fee plus any other fees due. 


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Updated: 05/05/08