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New Reseller Request

Name
E-mail 
Organization
Web-site (your existing website, if any)
Postal Address

Country
Phone
Fax
Years in Business
Initial Orders (number of new domains/sites you will order initially)
Expected orders
in a month
(number of new domains/sites you expect each month)
Deposit (Tick if willing to make an initial deposit to avail Instant Activation)
Comments
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