Reseller Information:

First Name: Last Name:

Company: Reseller URL:

Address: City: Zip:

State/Province: Country:

Phone: Email:

Desired Reseller I.D: (Pending availability)

Reseller Username:

What will you charge for each domain? (Must be greater than or equal to our current prices - listed below)

• .com: $/year
• .net: $/year
• .org: $/year

• .info: $/year
• .biz: $/year
• .name: $/year

• .us: $/year
• .cc: $/year
• .tv: $/year

(Optional Information):

Default Registrant:

Default Technical Contact:

Default Administrative Contact:

Default Billing Contact:

Default Nameservers: and