Domain Name Reservation Form

Domain Name
Reservation Form

IMPORTANT!
Please complete the form below to the best of your ability. If you are not sure about a particular entry, do not worry about it. But we do require that you include an e-mail address and phone number so we can contact you if it is necessary.

Describe in four or five words your organizationanization and/or the purpose for this domain name:

Your Email Address
Your Name (Last, First or Dept. Name)

Domain: (Please include the .COM, .organization, or .NET at the end.)
(ALL CAPS, PLEASE)
Please check the name's availability

Organization Information

  Name       
  Street     
  City        State   (2-letter abbreviation)
  Zipcode     Country Code  (2-letter abbreviation)

Domain Owner (Administrative Contact) Information

 
  Select Individual for individuals, Role for departments or groups.
   Individual  Role

  Name        (Last, First or Dept. Name)
  Company    
  Street     
  City        State   (2-letter abbreviation)
  Zipcode     Country Code  (2-letter abbreviation)
  Phone       Fax Number 
  Email

Domain Billing Contact Information

Select Individual for individuals, Role for departments or groups.
Individual Role

Name (Last, First or Dept. Name)
Company
Street
City State (2-letter abbreviation)
Zipcode Country (2-letter abbreviation)
Phone Fax Number
Email

Domain Technical Contact Information

Select Individual for individuals, Role for departments or groups.
Individual Role

Name (Last, First or Dept. Name)
Company
Street
City State (2-letter abbreviation)
Zipcode Country (2-letter abbreviation)
Phone Fax Number
Email

I would like to receive my InterNIC billing invoice via my:
E-mail Postal address.

BeOnTheNet should send its bill via email to the:

Admin Contact
Domain Billing Contact

Technical Contact

***Terms of Service***

Please read before continuing.

By requesting a Domain Name through this form I understand I am requesting BeOnTheNet
to process the above Domain Name on my behalf. I further agree to promptly
pay US $149.00 to BeOnTheNet for their services regardless of whether I choose to keep
the Domain Name in the future or not.

Payment Options

The U.S. $149.00 fee can be paid with Visa, Mastercard, or by check in U.S. funds.

Select your method of payment below:

Visa

Master Card

Check

Name as it appears on card
Credit Card Number
Expiration Date (mm/yy)

If you selected paying by check, please make the check payable to BeOnTheNet and mail it to the address below. We will not process your order until we receive your payment.

If you have any questions you can e-mail us at

webmaster@beonthenet.com

or call (631) 351-7699 - 1-888-632-9728.

BeOnTheNet Inc.
Providers of Practical Internet Solutions

5 Hartland Avenue - 3rd Floor.
Huntington Station, NY 11746
(631) 351-7699 - 1-888-632-9728
Fax: (631)980-4131

This Page Last Updated:

Name as it appears on card
Credit Card Number
Expiration Date (mm/yy)