The 1-Stop Cure-All Domain Registration Form
Brought to you by the staff of Animus Communications

Reseller Information

Your E-mail Address:
Your Name:
Reseller's Domain Name:

New Domain Information

Domain Name:
Organization Name:
Organization Address:
City, State & Zip:
Country:
   
Purpose of Domain:

Administrative Contact Information

Contact NIC Handle: - OR - Check here if you want Animus to be the administrative contact.
Type of Contact: Individual Role
Note: The rest of the contact information section should only be filled out if a contact has never been assigned a NIC handle. You can look up a contact's NIC handle by searching the whois database
Name (last, first):
Organization:
Street Address:
City, State & Zip:
Country:
Phone Number:
Fax Number:
E-Mail:

Technical Contact Information

Contact NIC Handle: - OR - Check here if you want Animus to be the Technical contact.
Type of Contact: Individual Role
Note: The rest of the contact information section should only be filled out if a contact has never been assigned a NIC handle. You can look up a contact's NIC handle by searching the whois database
Name (last, first):
Organization:
Street Address:
City, State & Zip:
Country:
Phone Number:
Fax Number:
E-Mail:

Billing Contact

Contact NIC Handle:
Type of Contact: Individual Role
Note: The rest of the contact information section should only be filled out if a contact has never been assigned a NIC handle. You can look up a contact's NIC handle by searching the whois database
Name (last, first):
Organization:
Street Address:
City, State & Zip:
Country:
Phone Number:
Fax Number:
E-Mail:


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© 1997 Animus Communications, Inc.
All rights reserved. Updated June 6 1997