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Account Information
 

Domain Name
www.
FREE Domain Name

 Sign up with us NOW for two years, prices starting as low as $9.95 per month,  and we will pay for your domain name registration!!  It's that simple!!  Until now, anyone wanting to register an internet address (yourname.com, .net, or .org)  typically had to pay $70.00 for a two-year registration with other registration services.   

Plan Type

Plan Length

Special Instructions

Additional products such as disk space and mail options must be requested via phone or e-mail.

Check here if you want Microsoft FrontPage extensions loaded for this account

Subscriber Information
First Name
Last Name

Company Name (if none, use your name)

Phone
Fax

E-mail Address

(a contract will be emailed to this address)

 

Address - Line 1

Address - Line 2

City
,
State
Zip

Province

Country

Payment Information
Payment Type:
Credit Card Information
Card Number:
Expiration Date:
First Name on Card:
Last Name on Card:
Billing Zip Code:
 This information will be used to verify your credit card authenticity.

 

Electronic Fund Transfer Information
Fill in this section only if you selected Electronic Payment for Savings, for Checking, or for Business Check.
Bank Routing #:
Bank Account #:
Bank Name:
First Name on Bank Account:
Last Name on Bank Account:

This graphic will help you fill out your
Electronic Fund Transfer Information

 

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