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Want to register your Domain Name off line?
Here you can order your Domain Name Registration
by postal
mail from anywhere in the world, and pay by check or money order.
Email or postal registration forms are located below:
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If you wish to send your Domain Registration by mail;
First check that the Domain is available by using our availability search form.
Then print this page, or copy and paste it to MS Word or Notepad, fill out the fields and mail
it to us with payment. If you prefer to email this form and postal
mail your payment, that's fine too. If you need assistance at any stage with this form please contact us
at:
Contact us
Send postal mail Domain registrations to:
Attn: Barry L. Brumfield
US Domain Registrar
PO Box 12702
Alexandria Louisiana 71315
USA
Mail or email registration pricing for .com .net .org .info .biz .US
2 year minimum $15.00 /yr - $30.00 total
5 year Registration $14.00/yr - $70.00 total
10 Year Registration $13.00/yr - $130.00 total
Form begins here:
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DomainName-ICANN.com
Domain registration text form
to be mailed in by postal or email only.
Domain Name/s Information:
1.Purpose/Description of Domain______________
_______________________________________
2. Domain Name/s_________________________
_______________________________________
3. Total number of Domains listed above____
4. Number of years registration per Domain ____
Organization Using Domain:
Organization Name ______________________
Street Address__________________________
City__________________________________
State_________________________________
Zip/Postal Code_________________________
Country_______________________________
Administrative Contact:
(The person that will own and be responsible for this Domain Name)
Name_________________________________
Organization Name_______________________
Street Address__________________________
City___________________________________
State__________________________________
Zip/Postal Code_________________________
Country Code___________________________
Phone Number__________________________
Fax Number____________________________
E-Mail Address__________________________
Billing Contact:
If the same as
Administration mark "same" here _______
If different complete below:
Name________________________________
Organization Name______________________
Street Address_________________________
City_________________________________
State_________________________________
Zip/Postal Code_________________________
Country___________________________
Phone Number__________________________
E-Mail Address_________________________
DNS (Hosting Company)
Fill in if you have a preference as to Hosting
Company,
if not we'll simply park your domain in our web servers for
free until
you decide on a Web Host .
DNS numbers if known or use the Company
name and we will look it up for you:
DNS 1________________________________
DNS 2 ________________________________
Address confirmation of registration will be sent to:
____________________________________
(Postal or E-Mail)
Minimum payment must be enclosed in the amount of
$30.00 total per Domain Name for two years registration.
Please make payment to: Barry L. Brumfield
Mail or email registration pricing for .com .net .org .info .biz .US
2 year minimum $15.00 /yr $30.00
5 year Registration $14.00 /yr $70.00
10 Year Registration $13.00/yr $130.00
Method of Payment:
Cashiers check ___
Money Order ___
Personal or business check___
(
checks must clear before registration can be made)
Credit Card Type_____
Card Number ________________________
Expiration Date_______________________
Name on Card__________________________________
(Must be exactly as on card)
Amount enclosed or to be charged to Credit card:______
(sign here)_____________________________ Date_________
Our support staff will contact you immediately upon receipt of this form.
Postal mailing address:
Attn: Barry L. Brumfield
US Domain Registrar
PO Box 12702
Alexandria Louisiana 71315
USA
If you prefer to Register online, please proceed to
our web based registration form on our
Main Domain Registry Page
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