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First Name:

Last Name:

Company:

Address:

Email:

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Please fill in your desired domain name.
We will register it for you and charge your account.
If you already have one, please fill it in.
Be sure to indicate the complete name (i.e. .com, .net)

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By clicking on the submit button you will be directed to a secure server to process your credit card payment. Your card will be charged $20.00 for a one time set up fee. Or you can phone us at: (716) 864-4731 to place your order. By Fax: (716) 836-9649 Use your browsers print button to print the form and fax it to us.

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