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Wholesale Additional Domains
Upon submission of this form the information you provide will be transferred to our secure server.
*
denotes a mandatory field
1. VISP Details
2. Contact Details
Title:
Email Address:
*
First Name:
*
Daytime Tel.:
*
Last Name:
*
Evening Tel.:
Fax Number:
3. Company Information
VISP Service Name:
VISP Domain:
4. Postal Address
5. Payment Details
Address:
*
Terms of Payment: In Advance Payment Method:
CHEQUE
Charges: £50.00 ex.VAT
CREDIT CARD
Card Type:
Postcode:
*
Card Number:
Expiry Date:
01
02
03
04
05
06
07
08
09
10
11
12
2000
2001
2002
2003
2004
2005
2006
Issue Number:
6. Name of Domain to be Transferred
Domain:
.co.uk
.net.uk
.org.uk
.com
.net
.org
Other
7. Security Information - Pertaining to the Wholesale Domain administrator
Date of Birth:
Mother's Maiden Name:
8. Your Comments
Declaration:
I hereby confirm that I have read and understood Abel VISP's Terms & Conditions and agree to be bound by the said Terms & Conditions. I wish to apply for the above Wholesale Domain. I understand that the above Wholesale Domain's Net connectivity will be through Abel's network and its on-line time will be added to my VISP call-share minutes. Please until further notice debit my credit / debit card annually at the applicable rate.
Advice:
You are strongly recommended to print a copy of this page.