Domain Name Registrations
Website Hosting, Domain Name Registration
Website Hosting, Domain Name Registration
Website Hosting, Domain Name Registration
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Domain Name Registration
Domain Availability Search - FREE Registration with all New Hosting Plans.
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05/28/2017 01:22:52 PM CDT

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Domain Name Registration Form

 

If you are ordering from a country or region that does not support encryption (SSL) please use our basic form.


  
* Indicates Required Field

Enter the domain(s) you wish to register
Enter up to 10 domain names.
Please be sure to include the domain extension (.com, .net, .org, .tel, .us, info, .tv*).
                              Need Assistance?
*Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Domain 6
Domain 7
Domain 8
Domain 9
Domain 10

Personal Information
*First Name
*Last Name
*Company
Organization Name

(if personal site, enter your last name ONLY)
*Street Address
*City
*State/Province
*Zip/Postal Code

*Country    

*Phone Number
Fax Number
*E-mail address
*E-mail address
confirmation
Purpose of Domain
How did you hear
about our service?

  

Payment Information
*Credit Card
*Name on Card
*Card Number
*Expiration Month
*Expiration Year
Credit Card ID Number(See Example)

I agree to pay $29.95 US to SiteLeader.com. for each .COM, .NET, ORG, .TV domain name
processed for registration.
.TEL, .US domains are $19.95 each.
SiteLeader.com will register the Domain(s) as entered above (if available).
This service is strictly for Domain name registration and a standard
Parking page.

Registration fees are non-refundable.

I accept the standard Customer Service Agreement
To accept, type an "X " in this box


   

* Indicates Required Field

 

Here is a sample of how to
find your card's ID number:



American Express:
4 digits on front of card

Back to Order Form



Visa and Mastercard:
3 digits on back of card

Back to Order Form

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