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I want to order a Subdomain for one year
Formular und Inhalt copyright by Klaus Huster Media-Network

FamilyName         Firstname
Customer-number         Procedure-number  
Home address postal code / zip and city  
Phone Birthday
Mobile-Phone Fax
Email existing email-address
Subdomain, you only have to pay a yearly fee of 10 Euro :

Domainname       .        if other:       

I want to order this subdomain   
If the subdomain is already taken / not available :   

One more Subdomain ?     Yes  /  No
Subdomains (2,3,4..) you want to order :   

Do you already have a homepage ?     Yes  /  No
Type in the URL of your Homepage    http://   

If you don`t have, type in the order you want to place (example: Your Name + email-Address should be seen on our homepage)   

      Please use this link, to pay with your credit-card

You`ve paid already?  Yes  /  No

other order :   


Do you like to have a phone-call ?  Yes  /  No

   © 2003 by Klaus Huster •  klaus.huster@media-network
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