Steadfast and Sure
  Domain Registration  Form

Instructions for payment by check:                          

(1) Please fill out this form

(2) Print it by right clicking on the form.  Click PRINT

(3) Enclose a check for the correct amount.   (See Chart)

(3) Mail form and payment to:
Anchor WebHost
1149 Wolcott Rd
Wolcott,  CT 06716

Domain Name Rates

.COM  .ORG.  .NET   .INFO   .BIZ

 $20.00

.US  2 Year  ($25.00@)

 $50.00
 .AGENT  .ARTS  .AUCTION  .CHAT  .CHURCH
 .CLUB  .FAMILY  .FREE  .GAME  .GOLF
 .INC  .KIDS  .LAW  .LLC  .LLP
 .TRAVEL  .LTD  .MED  .TECH  .SCHOOL
 .SCIFI  .SHOP  .SOC  .SPORT  .MP3
$30.00

 

Full Domain Name  www. 
First Name
Last Name
Organization  
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone(Optional)
Home Phone
FAX(Optional)
E-mail
URL(Optional)

DISCLAIMER: Requesting Domain Name(s) does not mean that the Domain Name(s) will be successfully registered. There may be more than one request for the same Domain Name(s) via different registrars. If the Registry informs us that we are able to register the requested Domain Name(s), we will register your Domain Name(s) and your account will be charged for the registration fee.

© 2004 Anchor WebHost LLC. All rights reserved.