Domain Name Registrations
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Domain Name Registration
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11/23/2017 04:53:28 AM CST

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Domain Name Registration Form
If you would prefer to register a .com, .net, or .org domain name, Click Here.

If you would prefer to FAX this form to us, use our Fax Form .  You will have to print out the form, fill it out, then fax it.

If you would prefer to use our secure form, and you are ordering from a country or region that does support encryption (SSL) please use our secure form.
  

  
* Indicates Required Field

Enter the domain(s) you wish to register
Enter up to 10 domain names.
Please be sure to include the domain extension (.cc, .nu, .to)
                              Need Assistance?
*Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Domain 6
Domain 7
Domain 8
Domain 9
Domain 10

  

Personal Information
*First Name
*Last Name
*Company
Organization Name

(if personal site, enter your last name ONLY)
*Street Address
*City
*State/Province
*Zip/Postal Code

*Country    

*Phone Number
Fax Number
*E-mail address
*E-mail address
confirmation
Purpose of Domain
How did you hear
about our service?

   

Payment Information
*Credit Card
*Name on Card
*Card Number
*Expiration Month
*Expiration Year
Notes/Comments

I agree to pay $29.95 US to Site Leader, Inc. for each Domain name processed for registration. This will be the ONLY amount billed by
Site Leader, Inc. to the credit card I have chosen above. Site Leader, Inc. will register the Domain(s) as entered above (if available). This service is strictly for Domain name registration and a standard "Coming Soon" page.
I agree to pay the organization that reserves the domain name(s) I have chosen, as explained below:
I understand that the organization that reserves all .CC Domain names will charge my credit card separately after the reservation of a .CC Domain is complete. It is my responsibility to pay if I have registered a .CC Domain name. The organization charges ALL .CC Domain names $60 US per year to remain reserved.
I understand that the organization that reserves all .NU Domain names will charge my credit card separately after the reservation of a .NU Domain is complete. It is my responsibility to pay if I have registered a .NU Domain name. The organization charges ALL .NU Domain names $45 US per two year period to remain reserved.
I understand that the organization that reserves all .TO Domain names will charge my credit card separately after the reservation of a .TO Domain is complete. It is my responsibility to pay if I have registered a .TO Domain name. The organization charges ALL .TO Domain names $100 US per two year period to remain reserved.

Registration fees are non-refundable.

I accepted the standard Customer Service Agreement
Please acknowledge with an "X "


   

* Indicates Required Field
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