Excell Internet Inc. will register your domain name with the Internic for a small fee. The registration process usually takes about two weeks.

Please fill out the following form and click "submit" when done. Alternatively, you can click here for a printable version of this form and then you can fax it to Excell Internet Inc. at (718) 548-0343.

Billing Information:

Warning -- this web server is not running any of the advanced security protocols, i.e. https or shttp, so if you don't feel comfortable sending your credit card information over the Internet, please print out the alternative version and then fax it to Excell Internet Inc. at (718) 548-0343.

Company

Contact

Address1

Address2

City

State

Zip

Telephone

Fax

Email

Name As It Appears On Card

Card Type

Card Number

Expiration

/

 

Domain Information:

Please provide three choices for domain names. We will register the first choice that is available. If you want to register more than one domain, please submit separate forms.

Domain Name

Domain Name (second choice)

Domain Name (third choice)

Domain Type

Commercial (.com)
Non-profit (.org)
Educational (.edu)
Government (.gov)
Other

Please provide a brief description of your company

Fees

Domain Registration = $102.84 ($95 + tax)

Internic Charges (to be billed directly by the Internic) = $50/year

 

 

Comments? Problems? Drop us some email at webmaster@excellnet.com
Last Update: Fri Apr 19 18:00:40 EST 1996
Copyright © Excell Internet Inc.