A.A.D. Domain Name Registration Form

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A.A.D. Domain Name Registration Form

"(Use this form only if you would like to register your domain name without purchasing A.A.D. Web Hosting, or Web Design Services. If this is not the service you are requesting, Click the Back Button on your browser, or Use the A.A.D. Site Navigation Links at the bottom of this page........)"

Click here to check domain name availability.

Requested Domain Name(s):
List the domain name below that you want registered.

***New Domain Name Registrations Only***
*** Please select the number of years for which you would like your domain registered. ***

Domain Name Requested:
www.

Enter the individual, or organization who will be the "legal entity", or Registrant to be bound by the terms of the Domain Name Registration Agreement:

REGISTRANT INFORMATION:

*Name:*
*Organization: (optional)*
*Street Address:*
*City:*
*State/Province:*
*Zip/Postal Code:*
*Country:*

Enter your contact information below. The contact listed below will be the contact authorized to make changes.

ADMINISTRATIVE CONTACT INFORMATION:

*Last Name:*
*First Name:*
*StreetAddress*
*City:*
*State:*
*Zip:*
*Country:*
*Phone:*
*Fax(optional):*
*Email:*

Note: This e-mail address will receive all account information and will be recognized as the contact authorized to make changes to domain name records.

TECHNICAL CONTACT INFORMATION:

*Last Name:*
*First Name:*
*Phone Number:*
*E-Mail:*

This section requires domain name hosting information. If you do not have the information below, please contact your technical contact, Internet Service Provider or Web hosting service now. Or to reserve your domain name without this information, A.A.D. can host your new domain.

REQUIRED INFORMATION:

	*HOSTNAME*	*IP ADDRESS*
*Primary Server:*

*Secondary Server:*
*Use A.A.D. Server*	*Check Here*

Please provide your e-mail address to receive your order confirmation for this domain name:

ADMIN E-mail Address (required):

The e-mail address provided must be an existing, working e-mail account, not e-mail associated with the domain name requested. Your order is not complete until you have received an e-mail confirmation.

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