Origin Internet Service : $55.00 Domain Registration

$55.00 Domain Registrations ...

Register your domain for only $55.00 per 2 years off our website and have your domain reserved and ready to be used in 2-3 days. Now you can own your own dot com for less than the typical $70.00 two year registration. Register your own domain name today!!

Registrant Information

Domain Name:

Owner Name:
Address:
City:
State/Province:
Postal Code:
Country Code:
Email:
Phone:

Contact Information

do NOT use InterNic handle!	CORE handles only - or leave blank!
Handle:
First Name:
Last Name:
Address:
City:
State/Province:
Postal Code:
Country Code:
Email:
Phone:
Fax:

Name Server Information

Enter the Nameserver information of your ISP here. If you do not have this information yet, you should leave them at the default values.

Primary Name Server
Hostname:
IP Address:

Secondary Name Server
Hostname:
IP Address:

Credit Card Information

I / We hereby authorize you to charge the domain name fee of US $55.00 (for 2 years, INCLUDES all NIC Fees!!!) to my credit card, information see below. Payment is due for successful registrations only.

*Method of Payment:	VISA MasterCard
Credit - Card No #:	* - - -
Expires:	*
Address ofCardholder	* Street address, City, Zip, State required * *
Name on Card	*
.	Payment Service: G & D International LLC 155 Wailea Ike Pl. #160, HI 96753, USA

* Do not press submit button more than once - please wait for processing.

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