Domain Name
Registration Order
Date: 01-06-2009
Company Name:

First Name:

Last Name:

E-mail address:

Telephone Number:

Street Address:

City: State: Zip:

Billing Address: same as the Service Address

If different from the Service Address:
Billing Address:
City: State: Zip:


Available Terms                           Rate
2 year registration                     $56.00            
5 year registration                     $126.00 *save 10%
10 year registration                   $238.00 ** save 15%

Domain Name to be Registered: http:// .

Additional Services                            Rate
Domain Name Parking                 $12.00 per year
Email Only Service                     $5.00 per month plus $49.00 one-time setup fee



AUTHORIZATION & AGREEMENT: Subscriber requests the above indicated domain name registration and/or related services from Stickdog. Stickdog agrees to expedite this request to secure the requested domain name. Subscriber understands and agrees to indemnify and hold Stickdog harmless for any loss incurred by Stickdog or Stickdog's suppliers as a result of the unavailability of the Subscriber's requested domain name and/or service. Subscriber agrees to pay fees in accordance with Stickdog's rate schedule listed above, and revisions thereto, provided that Stickdog provides notice to Subscriber of any rate increase at least 60 days prior to next payment due date.
I agree

STICKDOG TELECOM, INC.
143 A Church Street, NW Vienna, Virginia 22180
(703) 319-1700
customercare@stickdog.com