{{heading}} - Order Form
Congratulations on your decision to move forward with your business and register your own domain name. Upon completing the form below, you will be brought to a second page where you may verify that all of the information you have provided is correct. After you approve the information, simply click the "Order It!" button and you're done.
Domain Information
Domains:
Please Order only domains with the same extensions - e.g. you can blulk order mix of .COM .NET and .ORG (since they have the same price) - DO NOT MIX .COM/NET/ORG with .UK or with .TV as you would be charged incorrectly. Thanks!
Encoding Type:
NOTE: all of the above domains must have the same encoding type.
Registration Period: (2 years for .uk)
Profile: {{reg_profile}}
{{CUSTOM_TECH_CONTACT}} {{CUSTOM_NAMESERVERS}}
Registration Type: {{reg_type_text}}
Contact Information
First Name:
Last Name:
Organization Name:
Street Address:
# Symbol Causes Error in Registration
*optional* (eg: Suite 245):
*optional* Address 3:
City:
State:
Country:
Postal Code:
Phone Number: (eg. 416-555-1122)
*optional* Fax Number:
Email:
Credit Card Billing Information
Same as Contact Information
First Name:
Last Name:
Organization Name:
Street Address:
# Symbol Causes Error in Registration
*optional* (eg: Suite 245):
*optional* Address 3:
City:
State:
Country:
Postal Code:
Phone Number: (eg. 416-555-1122)
*optional* Fax Number:
Email:
Payment Information
Method of Payment: Expiration Date
Card Number: Month    Year 

You can also call in your credit card purchase, questions or technical support from 8:30 AM through 5:30 PM PACIFIC TIME - call (818) 365 0664 - we will have our customer service assist you in completing your order.