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First Name:

Last Name:

Company Name:

Telephone:

Fax:

E-mail:

Address:

Zip Code:

City:

State (Province):

Country:

The technical informations about your provider or subdomain are not necessary, if you want just to reserve a domain name.

Please choose one of these choices if you want to connect the domain name and a document on the web.

100 mb Web space with unlimited traffic and 20 e-mail accounts at a server of Secura for 60 US-Dollars/year

Connect the domain
with my domain/sub domain :

Use the IP-address
of this host :

First Name Server: IP-number:

First Name Server: name:

Second Name Server: IP-number:

Second Name Server: name:

Register for me this domain at the price of 180 US-$ (1 year) :

.com.br

.net.br

.sv

.dm

.co.vi

Register for me these domains at the price of 130 US-$ (1 year) per domain:

.com.sv

.org.sv

.com.jm

.net.jm

.org.jm

.hn

.com.hn

.net.hn

.org.hn

.edu.hn

.com.ni

.org.ni

.web.ni

.in.ni

.nom.ni

.co.ni

.info.ni

.net.ni

.biz.ni

Register and connect for me at the price of 100 US-Dollars (1 year) per domain:

.es

.com.es

.nom.es

.org.es

Register for me these domains at the price of 600 US-$ (2 years) per domain:

.tt

Register for me these domains at the price of 50 US-$ (1 year) per domain:

.com.mx

.mx

.net.mx

.org.mx

.edu.mx

.gob.mx

Register for these domains at the price of 100 US-$ (1 year) per domain:

.bz

.co.tt

.gd

.vc

.com.vc

.net.vc

.org.vc

.co

.com.co

.net.co

.org.co

.gov.co

.mil.co

.com.co

.web.co

.arts.co

.info.co

.int.co

.firm.co

.rec.co

.nom.co

Register for me these domains at the price of 150 US-$ (1 year) per domain:

.sr

.com.ar

.do

.com.do

.org.do

.web.do

.art.do

.ec

.com.ec

.com.gt

.com.pa

Register for me these domains at the price of 300 US-$ (1 year) per domain:

.com.bo

.bo

.com.py

.bs

Register for me these domains at the price of 120 US-$ (1 year) per domain:

.vg

.ms

.gs

.tc

Register for me these domains at the price of 130 US-$ (1 year) per domain:

.uy

.com.uy

.ag

.cl

.co.cr

.cr

.pe

.com.pe

.com.pr

.com.ve

.gy

.ht

.gp

.com.gp

.lc

.com.lc

.net.lc

.org.lc

.co.lc

.l.lc

.p.lc

Register for me this domain at the price of 1200 US-$ (1 year) :

.pr

Register for me this domain at the price of 400 US-$ (2 years) :

.ai

Register for me this domain at the price of 950 US-$ (1 year) per domain (this is the price for non-cuban applicants):

.cu

Register for me these domains at the price of 450 US-$ (1 year) per domain (this is the price for non-cuban applicants):

.com.cu

.org.cu

.net.cu

.edu.cu

.inf.cu

You can order also these domains:

from Austria

at-domains

from Italy like e.g. get.it!

it-domains

country-domains

country-domains

Your space for your free password and additional orders:

payment

I pay by PayPal to secura@domainregistry.de

I pay US-dollars by check

I bankwire the sum to your account at

Stadtsparkasse Köln, Konto-Nr.2007982305 (BLZ 370 501 98) S.W.I.F.T.:COLS DE 33 IBAN: DE59 3705 0198 0095 8029 55

You can withdraw the costs of the ordered domains from my credit card.

Credit card type:

Name on credit card:

Credit card number

Expiration date:

Three digits at the backside of your credit card:

By clicking at the button you accept our trade conditions, Registrants rights and responsibilites,the Uniform Domain Name Dispute Resolution Policy of the Internet authority ICANN and the rules of the NIC of the country level domain are the base of the business relationship between you and Secura GmbH concerning domain registration. By clicking you confirm the order of domains at the conditions above.