Please print and fill out the following order form:

Name:_________________________________________________________________

Address:______________________________________________________________

City:___________________________ State__________ Zip Code_____________

Country:________________________

E-Mail:_________________________

Phone:__________________________

Fax:____________________________

What type of account would you like?
 [] Basic Account
 [] Silver Account
 [] Gold Account

Would you like to sign-up for one year of service (10% discount)?
 [] YES
 [] NO  

What user name would you like:____________________

Alternate user name (in case the first choice is taken):__________________


What domain name would you like:__________________ (for Silver and Gold accounts only)

___ I have enclosed a check

___ I would like to pay by credit card
    Card Type (circle one):       VISA     MASTER CARD

    Credit Card Number:___________________________

    Expires mm/yy:________________________________


Signature__________________________________    Date___________________

If you have any questions, please send them to sales@addr.com.

Make checks payable and send entire ordering information to:
        ADDR.com 
        Att: New Accounts
        5575 DTC Parkway, Suite 100
        Greenwood Village, CO 80111

If paying by credit card you can also fax the form to (720)489-8484