Register Your Domain Name

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Complete Website Design and Hosting Packages

Domain Name Registration

- Obtaining your domain, having a piece of mind

To reserve your Domain Name please complete the following form

Your Name
Your Title
Company Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Please provide 5 choices of domain names that you would like, we will
contact you with the choices that ARE available, for your final selection:
EXAMPLE: Domain name registration .com, .net, .org, .biz,
.info.com.au, .net.au, .org.au

Tip: You can find Domain Names that are not already registered by Searching for Domain Names

Pricing

.com / .org etc:
US$ 18.00 per year

.com.au / .org.au etc:
AUD$ 150.00 for 2 years registration.

No.	Your Preferred Domain Name (e.g. www.yourname.com)
1
2
3
4
5

Please provide the following ordering information:

	BILLING
Credit Card Type
Cardholder Name
Card Number
CSC / CVV
Expiration Date

Do you have any additional information or questions?

Please type the letters from the image above into the space provided below.
(Type the characters as you see them, letters are case sensitive):
*

Click 1 time only please.

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