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[Domain Names Head Office] [Buy Domain Names and we will sell them for you]

To: Domain Names Head Office,
I hereby request you purchase the following Domain Names on my behalf (at a cost of US$29 each for 1 year), and list them FOR SALE (in accordance with your Term of Sale & Purchase)

List Your Requested Names here

Please insert FULL Domain Name including .com/.net/etc Reserve price
in US Dollars
www.
www.
www.
www.
www.
www.
www.
www.
www.
www.

    

 

By ticking this
box , I certify that
I understand, and I have
the authority to enter
into this agreement,
and I authorise the
credit card transaction
completed herein.

Subject to
"Terms of Sale"
 you may amend or remove your details
at any time.

 
Name:
Address:
City:
State:
Post/Zip-Code:
Country:
Email:
Telephone:
Total Amount: $US Dollars
Card Type: Visa MasterCard
Card Number:
Expiry Date: /
Name on Card:
I hereby request you to purchase and list the above domain Names FOR SALE on my behalf
(in accordance with your Terms of Sale)

 

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