Domain Name Registration Request Updated September 16, 1999 Return Please fill out this form, sign, and fax it to US Internet at (310) 581-2831. If you have questions, please feel free to call us first at (310) 581-2811 Registration is very inexpensive. Internic (Network solutions) charges $35.00 per year with a two year minimum to start, per domain name. This fee must be paid at the time of registration to Internic. Our registration fee is $50.00, and if you choose US Internet to host your web site, this fee is deducted from our standard set-up fee.
	Please print and complete the following and the fax it to us today. This information will be used to register your domain name. We will register the site under the domain name, and address you indicate below. Also, future billing will come directly from Network Solutions (Internic). US Internet will do everything it can to register this domain name promptly, but can not guarantee that the name is available. Confirmation of the registration will be forwarded to you at the completion of the registration. Domain Name: Your Name: Company Name: (If applicable) Address: City, State Zip: EMail: Telephone Number: Fax Number: Please have Network Solutions charge the following credit card for my two year registraion: $70.00 per domain name. I understand that an additional $50.00 will be charged by US Internet for this service. Card Type: Card Number/Expiration Date Name Signature