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If you prefer you can fill out this page, print it and mail or fax it to us. We will contact you concerning the payment process.
Account Information Absolutely No Adult, Warez or MP3 Sites Password: Verify Password: Domain Information Please check first to see if the domain name you want is available, and then fill in domain name (i.e. yourname.com, yourname.net, etc.) Domain Name: www. Is it a Transfer? No. it is a new domain Yes, please transfer my domain There will be a fee for new domain registration with InterNIC. Domain transfers and new registrations are $20.00. Account Add-On FrontPage® 2002 Extensions: (free!) Note that all prices are in US Dollars. New Domain Registration Information (Optional) Registrant/Organization Information: Organization Name: Organization Address: City, State, Zip Administrative Contact: Use my assigned NIC handle Use below information Name: Type of Contact: Individual Role Account Organization: Street Address: City, State, Zip Phone: Fax: E-Mail: Billing Contact: Use assigned NIC handle Use administrative contact information Use below information Name: Type of Contact: Individual Role Account Organization: Street Address: City, State, Zip: Phone: Fax: E-Mail: By typing your name above, and pressing the "Create Account" button below, you hereby agree to the Terms and Conditions and hereby authorize all expenses associated with this account. Notice: If you mail or fax this application, you must sign it before submitting it. Print Name: ____________________ Signature: _____________________ Note: After pressing "Create Account" you will be directed to the selection page to select the hosting/service you desire.
Domain Information Please check first to see if the domain name you want is available, and then fill in domain name (i.e. yourname.com, yourname.net, etc.)
There will be a fee for new domain registration with InterNIC. Domain transfers and new registrations are $20.00. Account Add-On
FrontPage® 2002 Extensions:
Note that all prices are in US Dollars.
New Domain Registration Information (Optional) Registrant/Organization Information:
Administrative Contact: Use my assigned NIC handle Use below information
Billing Contact: Use assigned NIC handle Use administrative contact information Use below information
By typing your name above, and pressing the "Create Account" button below, you hereby agree to the Terms and Conditions and hereby authorize all expenses associated with this account.
Notice: If you mail or fax this application, you must sign it before submitting it.
Print Name: ____________________ Signature: _____________________
Note: After pressing "Create Account" you will be directed to the selection page to select the hosting/service you desire.
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