Contract to order an email address

Hereby I request an email address of the type Yourname@Finkbeiner.net (Finkbeiners only).

Your name and address

Please indicate your complete address for an order:

Name
Street
ZIP
City and state
Country
Date of birth
Telephone
Fax
Email

Desired email address

Which email address would you like to have and be supposed on which already existing address the emails to be passed on automatically?

Desired name	@Finkbeiner.net
Forwarding destination email address
Expenses	I declare to agree to pay $1 pro month for expenses.
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SPAM-protection	Please type in the number "2".
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