My Web Form

CONFABEE LTD
Please Complete this form if you have paid to the Bank for your domain registration and/or web hosting .

First Name:

Last Name:

Email:

GSM Number: e.g. 08031234567

Office Phone Number: (optional)

Domain Name: (suggest at least 3 names)

Address: This will be used for registration

City or Town :

State:

Country:

Bank: (Where Deposit was made)

GTB

UBA

Amount Paid to Bank ( eg N10,000)

Date Deposit was made to the Bank:

Comment, Questions or any information you want us to note: