AlaWeb Domain Request Form

AlaWeb Domain Request Form

Please complete the following form to request your Domain Hosting Package. Please specify if the domain requested will be a .com, .net, or a .org domain.

I authorize AlaWeb to register the domain name listed below and to bill the $70 two-year registration fee* (new registrations only) and the $99 1-time setup fee to my AlaWeb account. I have also selected the desired Hosting Package below (billed monthly).

*Registrations are pending availability. Domain name renewals are billed prior to expiration, typcially two years after the initial registration.



Email:
Domain Name Requested:

Name:
Address 1:
Address 2:
City:
State:
Zip:

Phone:

Which Hosting Package Have You Selected?:	Limited Package at $5.95 monthly (requires AlaWeb account). Bronze Package at $29.95 monthly. Bronze Plus Package at $59.95 monthly. Silver Package at $99.95 monthly. Silver Plus Package at $129.95 monthly. Gold Package at $199.95 monthly.

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