LatinTLD Inc.

Please input the following data:

1.0. CUSTOMER NAME & COMPANY (Person in charge of this account)

1.1. First Name .....................*: 

1.2. Last Name ......................*: 

1.3. e-mail address..................*: 

1.4. Organization name  .................*: 

1.5. Country (2 letter ISO code).....*: 

1.6. Street Address..................*: 

1.7. Street Address 2.................: 

1.8. City............................*: 

1.9. State - Region...................: 

1.10. Postal Code.....................: 

1.11. TAX ID Number...................: 

1.12. Phone Number [C][A][Nbr].......*: 

1.13. Fax Number [C][A][Nbr]..........: 

1.14. For whom do you plan to register domains with this account?
(please mark all that apply) *: You Your Company Your Clients

1.15. Is person in charge of payments same as above?

Yes

1.1. First Name .....................*:
1.2. Last Name ......................*:
1.3. e-mail address..................*:
1.4. Organization name .................*:
1.5. Country (2 letter ISO code).....*:
1.6. Street Address..................*:
1.7. Street Address 2.................:
1.8. City............................*:
1.9. State - Region...................:
1.10. Postal Code.....................:
1.11. TAX ID Number...................:
1.12. Phone Number [C][A][Nbr].......*:
1.13. Fax Number [C][A][Nbr]..........:
1.14. For whom do you plan to register domains with this account? (please mark all that apply) *: You Your Company Your Clients
1.15. Is person in charge of payments same as above? Yes No

Please input the following data: