SiteWala - Domain Name Information Form

The following form must be completed in FULL for us to register your domain name with a registrar correctly. Instructions are provided at the bottom of the page. Registrant is responsible for the accuracy of name submission; names will be registered as submitted; any changes will entail an additional registration fee.

Incomplete forms will not result in domain registration or reservation. All fields except those marked * are required to be filled.

Domain Information
Complete Domain Name:
Your E-mail:
Organization (Registrant) Information
Organization Name:
Organization Address:
City, State, Zip:
Country:
Administrative/Billing Contact Information
Name (last, first):
Organization:*
Address:
City, State, Zip:
Country:
Phone:
Fax:
E-mail:
IMPORTANT!
Domain name registration subject to availability. Check availability. Submitting this form does not automatically register your domain name with a registrar. SiteWala will be the technical contact for your domain name. Domain registration charges [as applicable] must be paid together with domain parking fees. Instructions Complete Domain Name For second-level domain names under .COM, .ORG, or .NET insert the name of the domain you wish to register as in, "EXAMPLE.COM". The total length of the two-part (secondlevel.toplevel) name may be up to 67 characters (including the 4 characters .com). The only characters allowed in a domain name are letters, digits and the dash (-). A domain name cannot begin or end with a dash. Registrant is responsible for the accuracy of name submission; names will be registered as submitted; any changes will entail an additional registration fee. Domain Name Registrant The domain name is considered to be registered to a "legal entity", even if the legal entity is an individual (e.g., Lee Smith). Do not list a "dba" or acronym as the registrant. In this section, it is important to list the legal name and address of the Registrant, not the Internet Service Provider ("ISP"). Administrative Contact The Administrative/Billing Contact/Agent is the person or organization authorized by the domain name Registrant to act on behalf of the legal entity listed under Registrant. The Administrative Contact/Agent should be able to answer non-technical questions about the legal entity's plans for using the domain name and the procedures for establishing sub-domains. Organization name - Enter name of organization represented by the individual. Name - Place the name of the Individual or Role being registered. For Individuals, supply the full name (last, first and middle initial). Do not use titles. If suffixes are used, such as "Jr." or "III", separate the name from the suffix with a comma. Street Address - Multiple entries must be separated by a comma. Phone Number - Multiple entries must be separated by a comma. Fax Number - Multiple entries must be separated by a comma. Email Address - Enter a valid POP e-mail address.

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