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:  
                      Name above is of an Individual
                      Name above is of a Role, President etc.
                     
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:  
                      Name above is of an Individual
                      Name above is of a Role, President etc.
                     
Organization Name:   
Street Address:      
City:                
State:               
Postal Code:         
Country:             
Phone Number:        
Fax Number:          
E-Mailbox: