Domain Lender
Sign-up Form

Providers of dialup Internet access since 1990

I hereby confirm that I have read and understood Domain Lender's Terms & Conditions and agree to be bound by the said Terms & Conditions. I wish to join Domain Lender and become a VISP by borrowing a Domain(s).
Upon completion of this form your information will be transferred to our secure server.
First Name:  Surname: Company Name:  Position in Company:
   
Address: County/Region: Post code:
Day telephone no: Evening no: Fax number: Current Email:
Please until further notice debit my credit / debit card bi-annually (every two years) for the sum of: 
Set up Fee: £50.00 exVAT 
Bi-Annual Fee: £25.00 ex VAT  
Credit Card Company: Credit Card number: Expiry date: Issue Number-Switch
My chosen Domain from  pre-registered list is:
I do not wish to choose from Abel's pre-registered list, the domain name I would like to use with this service is:
 
1st Choice: 2nd Choice: 3rd Choice: 4th Choice:

Specific requirements or comments?

Where did you hear about Abel Internet's, Domain Lender service?

Your accuracy is appreciated and your privacy will be respected: