1. Domain Name |
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2. Domain details |
2a. (N)ew (M)odify (D)elete |
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2b. Purpose/Description.
If Modify, describe
fields to be modified |
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3.Organization Using Domain Name |
3a. Organization Name |
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3b. Street Address |
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3c. City |
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3d. State |
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3e. Postal Code |
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3f. Country |
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4.Administrative Contact |
4a. NIC Handle (if known) |
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4b. Name |
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4c. Organization Name |
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4d. Street Address |
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4e. City |
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4f. State |
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4g. Postal Code |
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4h. Country |
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4i. Phone Number |
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4j. Fax Number |
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4k. E-Mailbox |
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5.Technical Contact |
5a. NIC Handle (if known) |
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5b. Name |
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5c. Organization Name |
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5d. Street Address |
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5e. City |
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5f. State |
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5g. Postal Cod |
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5h. Country |
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5i. Phone Number |
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5j. Fax Number |
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5k. E-Mailbox |
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6.Billing Contact |
6a. NIC Handle (if known) |
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6b. Name |
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6c. Organization Name |
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6d. Street Address |
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6e. City |
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6f. State |
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6g. Postal Code |
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6h. Country |
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6i. Phone Number |
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6j. Fax Number |
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6k. E-Mailbox |
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7.Primary Name Server |
7a. Primary Server Hostname |
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7b. Primary Server Netaddress |
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8.Secondary Name Server(s) |
8a. Secondary Server Hostname |
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8b. Secondary Server Netaddress |
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9.Payment Method |
9a. (B)ank transfer |
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9b.(E)urocard/MasterCard |
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9c.(V)isa |
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