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Service Application - Package 2

Please submit your application online. An accounts representative will review and respond within 24 hours from submission with instructions on how to access your new account and to set up payment and support procedures.

Last Name:
First Name:
Domain Name:
Is the Domain registered?:	Yes No
Email:
Address:
City:
Province/State:
Country:
Postal Code:
Payment Frequency:	Yearly Quarterly Monthly
Payment Method (Choose one):	Paypal (requires Paypal signup) Cheque Credit card through Paypal (requires Paypal signup) Transfer Other
Phone Number:
Choose a Security Code:

Other Notes:

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