Check Payment Request Form - Print and send with payment.


Mailing Address:

@Com Technology, LLC
2611 Intrigue Ln.
Brentwood, CA 94513

Check Payable:@Com Technology, LLC

I am requesting to make a payment by check or money order. I understand that it may take 2 weeks to process my order.
Domain Name:
Payment Amount:
Name of Requestor:
Contact Email Address:


Signature of Requestor: ______________________________________________________
Date:

Important Information:
Please send this form with your payment to the address above. You must also include a $5.00 processing fee.