Rconnection, a division of Register.com -- New Partner Account


RESELLER PROGRAMS PRODUCTS & SERVICES MARKETING SUPPORT CENTER VERTICAL MARKET SOLUTIONS

NEW PARTNER ACCOUNT

New Partner Account

In order to setup your account, we need to know who you are. Please provide complete and exact information. A "*" indicates a required field. A "*" indicates a field required for organizations only (if organization name provided). The information is required for billing and administration purposes.

Organization (or Individual) Information

Your Name (first) *

Your Name (last) *

Organization Name

Your Role/Title *

Postal Address Line 1 *

Postal Address Line 2

City *

	US State *
	Province
	Not Applicable (leave province blank)

Postal or Zip code *

Country *

E-mail Address *

Telephone *
Country
Number	Ext.

Fax
Country
Number

Credit Card Information

You are required to enter your credit card information on this secure site to create an account. Your credit card will be billed for the amount of the account prefill you specify.

Please enter information as it appears on your statement.

Type of Credit Card *

Cardholder's Name *

Credit Card Number *

Expiration Date *
/

CVV2 *

Cardholder's street address *

Cardholder's City *

State *

Zip/Postal *

Country *

Telephone *
Country
Number

Initial Prefill Amount *

(Total prefill amount must be at least $250.00 and cannot exceed $3000.00)

Login ID and Password Information

Choose a Login ID (no spaces or special symbols) *

Choose a Password (use at least 6 characters) *

Confirm the Password (re-type the password) *

Secret Word Type (if you lose the password) *

Secret Word *

I agree to Register.com's Services Agreement *

CVV2 Help

Do you need help locating your
CVV2 number? (click here)

Hint: The CVV2 is usually last 3
digits on the back of the card.