Abel Corporate Services  
Order a ADSL Domain Name for use with your Abel Service
Abel Biz
 ADSL New Domains
Upon submission of this form one of our advisors will contact you.
* denotes a mandatory field
 1. Client Details
 2. Contact Details
 Title:
 Email Address:
 *
 First Name:
 *  Daytime Tel.:
 *
 Last Name:
 *  Evening Tel.:
 Fax Number:

 3. Postal Address
 4. Payment Details
 Company Name:
 * Terms of Payment: In Advance                         Payment Method:
 CHEQUE
 Address:
 * Annual Charges: £75.00 ex.VAT
 CREDIT CARD
 Card Type:
 Card Number:
 Postcode:
 *  Expiry Date:
 Issue Number:
 5. Registration of a New ADSL Domain
 1st Preference:
    * Official ADSL Domain Records to show registered owner's name,
     address and postcode as:
 2nd Preference:
 
 3rd Preference:
 

 6. Security Information - Pertaining to the ADSL Domain administrator
 Date of Birth:
 Mother's Maiden Name:

 7. Your Comments

Declaration: I hereby confirm that I have read and understood Abel Biz's Terms & Conditions and agree to be bound by the said Terms & Conditions. I wish to apply for the above ADSL Domain. I understand that the above ADSL Domain's Net connectivity will be through Abel's ADSL, 0845 or Unmetered network (ADSL or Unmetered charges as per Abel's Website). 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.