You must fill out sections 2, 3, and 6


Authorization 




0a. (N)ew (M)odify (D)elete....: 
0b. Auth Scheme................: 
0c. Auth Info..................: 

1.  Comments...................: 
 You MUST fill in Line 2
2.  Complete Domain Name.......: 

Organization Using Domain Name
You MUST fill in Lines 3a thru 3f
3a. Organization Name..........: 
3b. Street Address.............: 
3c. City.......................: 
3d. State......................: 
3e. Postal Code................: 
3f. Country....................: 


Administrative Contact
4a. NIC Handle (if known)......: 
4b. (I)ndividual (R)ole?.......: 
4c. Name (Last, First).........: 
4d. Organization Name..........: 
4e. Street Address.............: 
4f. City.......................: 
4g. State......................: 
4h. Postal Code................: 
4i. Country....................: 
4j. Phone Number...............: 
4k. Fax Number.................: 
4l. E-Mailbox..................: 

Technical Contact
5a. NIC Handle (if known)......: 
5b. (I)ndividual (R)ole?.......: 
5c. Name(Last, First)..........: 
5d. Organization Name..........: 
5e. Street Address.............: 
5f. City.......................: 
5g. State......................: 
5h. Postal Code................: 
5i. Country....................: 
5j. Phone Number...............: 
5k. Fax Number.................: 
5l. E-Mailbox..................: 

Billing Contact
You MUST fill in Lines 6b thru 6l
6a. NIC Handle (if known)......: 
6b. (I)ndividual (R)ole?.......: 
6c. Name (Last, First).........: 
6d. Organization Name..........: 
6e. Street Address.............: 
6f. City.......................: 
6g. State......................: 
6h. Postal Code................: 
6i. Country....................: 
6j. Phone Number...............: 
6k. Fax Number.................: 
6l. E-Mailbox..................: 
This one, 6l. E-Mailbox, is very important

Prime Name Server
7a. Primary Server Hostname....: 
7b. Primary Server Netaddress..: 

Secondary Name Server(s)
8a. Secondary Server Hostname..: 
8b. Secondary Server Netaddress: 
8c. Secondary Server Hostname..: 
8d. Secondary Server Netaddress: 


Registration Period
9a. Registration Period........: