Domain {{reg_text}} - Order Form
Congratulations on your decision to move forward with your business and register your own domain name. Upon completing the form below, you will be brought to a second page where you may verify that all of the information you have provided is correct. After you approve the information, simply click the "Order It!" button and you're done.
NOTE: Owner contact can only be changed once the transfer has been completed.
{{AUTO_RENEW}} {{LOCK_DOMAIN}}
Domain Information
Domains Desired: {{domains}}
Registration Period:
Profile: {{reg_profile}}
{{CUSTOM_TECH_CONTACT}} {{CUSTOM_NAMESERVERS}}
Registration Type: {{reg_type_text}}
Admin Contact Information
First Name:
Last Name:
Organization Name:
Street Address:
*optional* (eg: Suite #245):
*optional* Address 3:
City:
State:
Country:
Admin contact must reside in Germany
Postal Code:
Phone Number:
(eg. +1.4165551122x333)*
*optional* Fax Number:
(eg. +1.4165551122)*
Email:
Must be currently valid address
Zone Contact Information
Same as Admin Information
First Name:
Last Name:
Organization Name:
Street Address:
*optional* (eg: Suite #245):
*optional* Address 3:
City:
State:
Country:
Postal Code:
Phone Number:
(eg. +1.4165551122x333)*
Fax Number:
(eg. +1.4165551122)*
Email:
Must be currently valid address
{{CC_FIELDS}}
Payment Information
Please ensure you are obtaining payment with the information gathered. This template does no credit card processing by default.


* - Phone and fax formats are as follows (extention is optional):
    +{country_dialing_code}.{phone_number}[x{extension}]
    eg. "+44.02055511928"


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