Application Form "Yourname.com" $29 per year
"Submit" to us online or fax this page to us to quickly process the setup.
Or print and mail this form with payment to address below.
Names: Personal, Family, Clubs, Groups, Business
For availability
enter up to
3 choices		 1
2
3		 eg:
myfamily.com
mybussines.com
myclub.org

Information

Your entry must match the name and address on your credit card.
First name
Last name
Bus. Organization
(Optional)
Email address
Web addr. URL if any
Street address
City
State
Zip/Postal
Phone (with AC) 
Fax
Information is kept strictly confidential
Expire
Make checks and money orders payable to TimcoUSA.
Mail
Email or
FAX
361/    664-3215
TimcoUSA
If you prefer you can email this form here 
this is a secured site. Just press submit

Regional office 427 So. Reynolds St., Alice, Texas 78332
If mail or fax:
YOUR SIGNATURE :_______________________________      Date ___________________________