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MyCommunity Registration Form


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Community Information

*
 
Community's Legal Name
 
*
 
Community Short Name
 
*
Address 1
 
Address 2

*
 
City
 
*
 
State

*
 
Postal Code
   
*
 
Country

*
Phone
ex: 123-456-7890   
Email Address
 

If you currently have a Domain Name enter it below, else enter the desired Domain Name.
Current Domain Name
ex: http://DomainName.com 

Desired Domain Name (subject to availability at additional cost)
First Choice

Second Choice

Third Choice


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Management Information:
Company Name

Short Name

Address 1

Address 2

City

State

Postal Code
 
Country

Phone
ex: 123-456-7890 
FAX
ex: 123-456-7890 
Member Services Email
 
Unattended Email
 
Accounting Email
 
Managers Name

Managers Email
 

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Signatures:
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Signature
  Dated: 12/5/2019
I certify that the information provided on this form is true.
That I have read and agree with the Terms and Services.
I understand that by typing my name in the box above it will serve as an electronic signature
.
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Your Title
 
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Contact Email Address
   


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