Webistration
INSTRUCTIONS: Complete all questions and click the SUBMIT button at the bottom.
First Name
Last Name
Address Line 1
Address Line 2
City
State
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
ZIP
Phone Number
Current E-Mail/
Forwarding Address
(me@mydomain.com)
Requested E-Mail Addresses:
Account Type
Address #1
@DelMar.cc
Mailbox
Forward
Address #2
@DelMar.cc
Mailbox
Forward
Address #3
@DelMar.cc
Mailbox
Forward
Address #4
@DelMar.cc
Mailbox
Forward
Address #5
@DelMar.cc
Mailbox
Forward
How did you
hear of us?
What is the
most important
feature for you?
A Del Mar e-mail address
Eliminate unwanted advertising
Minimize SPAM
Never having to change my address
Convenient access to my mail from anywhere
Remove advertising from my address
Mail name I wanted was available
Automatic forwarding to another address
A mailbox accessible from anywhere
Combination pop3 and webmail access
Three different webmail clients
Other (please notate in additional comments)
Check Box if you are under 13 years of age
E-Mail Address
of Parent
(Required if box
above is checked)
(p@mydomain.com)
Additional Comments:
Please do not use special characters.
Thank you for your business!
By clicking the submit registration button you agree to be bound by our
terms and conditions
and certify that all information provided is true and correct.
Copyright © 2003 DelMar.cc. All rights reserved to Business Applications LTD. A California Business Trust
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