AU and NZ Domain Registration

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02 Jul 2009

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Registration

*Note: Membership to this portal is Verified. Once your account information has been submitted, you will receive an email containing your unique Verification Code. The Verification Code will be required the first time you attempt to sign in to the portal environment. All fields marked with an asterisk (*) are required.

First Name:	*
Last Name:	*
User Name:	*
Display Name:	*
Password:	*
Confirm:	*
Email Address:	*
Website:
IM ID:

Address:	*
Street (cont.):
City:	*
Country:	*
Region:	*
Postal Code:	*
Telephone:	*
Cell:	*
Fax:	*

Language:
Time Zone:

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Domain Registration

Domain:	www.
Please provide the registrant details for this domain name and check that the details are correct. Once submitted and paid changes cannot be accepted. Refunds are not available once a domain name has been issued.
First Name:
Last Name:
Organisation	this will be the registrant
Street1
Street2
Street3
City
State	Non Australian
Post Code
Country
Email
Please Re-enter Email
After Hours Phone	Phone number must be of format +(international code).(areacode & number) eg a Sydney number would be +61.298889888
Work Phone
Mobile	Mobile number must be a 10 digit number eg 0400 000 000
Fax


Eligibility type
Registrant Id	Please select type and enter number Type Number
Policy Reason
Policy Reason Description	Please enter a explanation of why the registrant is eligible for the requested name under the selected policy

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