Planetmind Hosting Services
Park A Domain
Use this form to
reserve
a domain name. The domain will be yours for 2 years (no one else can take it),
but it will not be hosted
(it won't be accessible via the web). Use
this form
to order a hosted domain. Cost is $50 for setup.
Yellow fields are required.
Your Name:
Domain Name you'd like to reserve:
.com
.net
.org
REGISTRATION INFO
Registrant Name:
Registrant Company:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Email:
Phone:
BILLING INFO (if different)
Bill to Name:
Bill to Address Line 1:
Bill to Address Line 2:
City:
State:
Zip:
Email:
Phone:
PAYMENT INFO
Check, Visa and Mastercard are accepted for payment. Please send checks to:
Planetmind Internetworks
PO Box 1244
Nederland, CO 80466
Credit Card Information
(THIS IS A SECURE FORM)
Name on Card:
Card Number:
Exp. Date (mm/yy):
