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SECURE Domain Name Order Form

SECTION 1: Personal Information
How did you find us?:
Your Name:
Your E-mail Address:
Your Telephone Number:
Additional Comments:

SECTION 2: Payment Information

We must receive your payment before we can process your order. NOTE: If you do not want to have this information e-mailed to us, you can call us in person at our voice number or Fax us your Credit Card number, OR you may fill out this form, print it out and Fax it to us.
Our voice number is: (514) 906-0888, our Fax number is: (514) 906-0626.

 Credit Card Number:
 Credit Card Expiration Date:

SECTION 3: Domain Registration Information

THAT'S IT! After submitting, a thank you page will automatically appear - this indicates that we have successfully received your information. Your Domain Name Registration should be completed within 24 hours of receipt of your order, if payment is included.

We don't have any small print, so please read the following carefully before pressing the submit button: By submitting your order you acknowledge that you agree to pay A1 WebDesign Co. for Domain Name Registration and/or Hosting. You understand that without exception, there are no refunds for these services. Please read our Terms of Use Policy before placing your order. All prices on this web site are in US Dollars.

© A1WebDesignCo. Since 1995 All rights reserved.