[ URL ftp://ftp.plig.org/pub/templates/domain-template.txt ] [ 08/2002 ] **************** Please DO NOT REMOVE Version Number *************** Template Version Number: 1.3 ******************************************************************** Instructions for filling in this form can be found at http://www.za.net/instructions.txt ******************************************************************** 1a. Domain Name.....................: Request type is NEW, MODIFY, MANUAL-MODIFY or DELETE 1b. Request Type....................: Organisation 2a. Name............................: 2b. Street Address..................: 2c. City............................: 2d. Post Code.......................: 2e. Country.........................: Administrative Contact 3a. Name and Surname................: 3b. Organisation Name...............: 3c. Street Address..................: 3d. City............................: 3e. State or Province...............: 3f. Postal Code.....................: 3g. Country.........................: 3h. Phone Number....................: 3i. Fax Number......................: 3j. Email Address...................: Technical Contact 4a. Name and Surname................: 4b. Organisation Name...............: 4c. Street Address..................: 4d. City............................: 4e. State or Province...............: 4f. Postal Code.....................: 4g. Country.........................: 4h. Phone Number....................: 4i. Fax Number......................: 4j. Email Address...................: Primary Name Server 5a. Primary Server Hostname.........: 5b. Primary Server IP Address.......: Secondary Name Server(s) 6a. Secondary Server Hostname.......: 6b. Secondary Server IP Address.....: 7a. Secondary Server Hostname.......: 7b. Secondary Server IP Address.....: ******************************************************************** The completed form should be mailed to auto-dbm@za.net By submitting this form you agree to the terms and policies at http://www.za.net/policy.html ********************************************************************