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(*fields
are required)
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Domain
Information
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| Required
Web Site: |
* |
| Registration
Period: |
* |
|
Note:
if u already buy a domain then plz write "no
domain required"
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|
Hosting
Information
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|
Hosting Plan: |
* |
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Registrant
Information
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| Organization: |
* |
| First
Name: |
* |
| Last
name: |
* |
| E-mail
Address: |
* |
| Address: |
* |
| City: |
* |
| State/Province: |
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| Postal
Code: |
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| Country: |
* |
| Phone
Number: |
* |
| Fax
Number: |
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|
I
AGREE (AND AM AUTHORIZED BY MY ORGANIZATION TO AGREE)
to all items in the terms & conditions of use
and Billing Policy:
|
| Agreement: |
Yes
Not * |
| |
|
|
Web
Development Project Information (if
u want to develop then required)
|
| Title: |
|
| Project
Summary : |
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| Budget
($/Rs) : |
|
| Pages: |
|
| Date
of Completion: |
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| Current
Website: |
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| Site
u like as Demo 1: |
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| Site
u like as Demo 2: |
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Designing
and Dynamic Contents
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|
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| Special
Request : |
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Payment
Mode Details
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|
Currently
we are not accepting Credit Cards. Credit card fraud
is a felony. so, Please send payment via Check or
Money Order.
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|
Mail
a print-out of the this form to us along with a check,
money order, or cashier's check for the total signup
cost drawn in US funds or Pak Rupee to the address
given below. Be aware that your domain registration
or account creation will not be made until we receive
payment, which may mean that your domain name could
be already registered by that time.
|
| Bizline |
Rizwan ur Rehman |
| Office
# 08, 1st Floor, Madina
Centre, |
| Satyana
Road, Faisalabad-38000 |
| Pakistan. |
| Voice: |
|
+92-(0)41-8712214, 8715081 |
| Mob: |
|
+92-(0)300-6630493 |
Fax: |
|
+92-(0)41-8715081 |
| Sales: |
|
sales@bizline.com.pk
|
|
