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Please Note: All values in the form below are required (except for fax number). You will see notes from time to time on this page where customers have made common mistakes in filling out this form. It is important that this form be filled out properly, otherwise your domain name registration may be delayed while we fix the errors. Upon receipt of this form we will register your domain name for the time specified below.  If you have any questions, please contact our Support Team.

Domain Name:  (Example: mydomain.com)
(IMPORTANT: Please include the extension i.e. .com, .net, org)
Registration Period: 
  
Registrant/Company Information
Registrant or
Company Name:
Registrant or Company Address:
City, State:
Zip:
Country:
  

Administrative Contact Information
IMPORTANT: Please fill in all fields below except where noted

Use assigned NIC Handle: (NOTE: Please leave this field blank)

Or provide all of the contact information below:

Name (last, first):  
(PLEASE: Don't forget the comma)
Type of Contact: Individual Role Account
Organization:
Street Address:
City, State:
Postal Code:
Country:
Phone Number:
Fax Number:
E-Mail:
  

Technical Contact Information
Please Note: RealPro is automatically set as the technical contact of your domain.
Please do not enter any information here and skip down to the next section.

Use assigned NIC Handle: (NOTE: Please do not change this setting)

Or provide all of the contact information below:

Name (last, first):  Please leave blank
Type of Contact: Individual Role Account
Organization: Please leave blank
Street Address: Please leave blank
City, State: Please leave blank
Postal Code: Please leave blank
Country: Please leave blank
Phone Number: Please leave blank
Fax Number: Please leave blank
E-Mail: Please leave blank
  
Billing Contact Information
IMPORTANT: Please fill in all fields below except where noted
Use assigned NIC Handle:  
(NOTE: Please leave this field blank)

Or provide all of the contact information below:

Name (last, first):  
(PLEASE: Don't forget the comma)
Type of Contact: Individual Role Account
Organization:
Street Address:
City, State:
Postal Code:
Country:
Phone Number:
Fax Number:
E-Mail:
  
Name Server Information
Please do not change this information.
Primary Server Hostname:
Primary Server Netaddress:
Secondary Server Hostname:
Secondary Server Netaddress: