DOMAIN REGISTRATION / HOSTING ENQUIRY FORM

Please complete the form below if you are interested in registering a domain name, or in web hosting or other services. There is no obligation at this stage. However, please ensure that you have read Nominet's and our terms and conditions before purchasing a domain name

Name:  Job Title:  Company Name:  Company No (only for .ltd.uk):  Address 1:  Address 2:  Post Town /County:  Post Code:  Country:  Argentina Australia Austria Belgium Brazil Canada Chile China Colombia Croatia Czech Republic Denmark Finland France  Germany  Greece  Hong Kong  Hungary  India  Irish Republic  Israel  Italy  Japan  Korea, North  Korea, South  Luxembourg  Malaysia  Mexico  Netherlands  New Zealand  Norway  Peru  Poland  Portugal  Russia  Singapore  Slovak Republic  Slovenia  South Africa  Spain  Sweden  Switzerland  Taiwan  Thailand  Turkey  United Kingdom  United States of America  Uruguay  Venezuela  Zimbabwe  Telephone:  Your Current Email:  Verification Number: (Please enter the number from the image box opposite)

Domain: Legal Owner: How did you find us?: [Select] ------------------- Search Engine Browsing ------------------- .net magazine Architect.net Business Age Computers and Law Evening Standard Financial Times Internet Advisor Internet Business 'Internet' magazine Internet Today Internet Works Internet World Marketing Magazine Marketing Week Monitor Professional Webmaster Real Business Revolution SoHo Life SportFirst Sunday Business Sunday Times Trademark World Web Ireland Web Space ------------------- MailShot Recommendation Used Before ------------------- Comments: Services required for this domain: Domain Name Only Domain & Multiple Email Domain & Mult Email & Standard Webspace Domain & Mult Email & Small Biz Webspace Standard Webspace Small Biz Webspace Single Email Multiple Email Multiple Email & Standard Webspace Multiple Email & Small Biz Webspace Catalogue Secure Form Further Details

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London SW15 2RS UNITED KINGDOM

Tel: 020 8875 0200, Fax: 020 8874 3100

Email: sales@electricnames.co.uk

© 1995-2008 Electric Names

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