DOMAIN REGISTRATION FORM

1.) All entries must be filled in completely.
2.) Do not use "Same as above" to duplicate data.  
3.) Only fill in BILLING CONTACT if it is different than
    ADMINISTRATIVE CONTACT, in which case fill it in *COMPLETELY*
4.) Phone numbers and e-mail addresses are mandatory, faxes are optional.
SELECT ONE Setup Monthly Yearly IP Domains have their own unique IP number. NON IP Domains share the IP number of the web server. You may place as many domains as you wish under one web hosting account. Web hosting account is $10/month or $100/year. Domain charges are on top of web hosting charges. To find out more DOMAIN OFFERINGS IP Domain $ 0 $20 $200 NON IP Domain $ 0 $10 $100 Cold Storage $ 0 --- $25 YOUR LIGHTLINK E-MAIL ADDRESS, eg. homer@lightlink.com E-mail Address: SELECT ONE New New registrations only Modify Move or Modify existing registration DOMAIN NAME BEING REGISTERED (Do not include www or http://) Domain Name: ORGANIZATION USING DOMAIN NAME Organization Name: Street Address: City: State: Postal Code: Country: ADMINISTRATIVE CONTACT NIC Handle if known: Name (Last, First): Individual or Role: Organization Name: Street Address: City: State: Postal Code: Country: Phone Number: Fax Number: E-Mailbox: BILLING CONTACT IF DIFFERENT FROM ADMINISTRATIVE CONTACT DO NOT FILL THIS IN PARTIALLY, EITHER LEAVE BLANK OR FILL IT IN COMPLETELY! NIC Handle if known: Name (Last, First): Individual or Role: Organization Name: Street Address: City: State: Postal Code: Country: Phone Number: Fax Number: E-Mailbox: