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Account Order Form
To begin your new web site with NXWeb, please fill out the form below and then click
the "Submit Order" button.

First Name:
Last Name:
Company Name:
State, Zip Code    
Phone, Fax: -          -
Service Plan Type:
Domain Name:
Domain Name Status: New Domain Name (Searched and Proven available on previous page.)
Transfer of Existing Domain Name
Special Requests or Information:


A confirmation email will be sent to you as well as
the service agreement for your plan.
Thank you for your business.

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