1521 High Street

Domain Hosting Application Form      

Glen Iris  3146
Phone:  03 9885 4655

 Domain Name Registration/Delegation

Domain Name:
First Name: Phone:
Surname: Fax:
Email Address:
   The domain name is already registered and the Domain Password is:
   We require registration of the domain name for the organisation detailed below.

 Domain Name Registration ($80 for 2 Years)

Organisation Name:
Postal Address:
Suburb:     Postcode:
 Registration Number:
Organisation Type:
   ACN (Australian Company Number)    ABN (Australian Business Number)
   RBN (Registered Business Number) State:
   Other, please explain:
Eligibility Type:
   Company    Club    Religious/Church Group
   Sole Trader    Charity    Non-profit Organisation
   Registered Business    Trade Union    Incorporated Association
   Trademark Owner    Political Party    Commercial Statutory Body
   Pending TM Owner    Industry Body    Other
Claim Type:
   Name of a service which we provide    Exact match for business name or trademark
   Refers to program we administer    Abbreviation of business name or trademark
   Name of event that we sponsor    Acronym of business name or trademark
   Name of activity we teach or train    Name refers product we build or manufacture
   Refers to a venue which we operate    Name of the profession practiced by us or our employees
I agree that the above details are true and correct. I understand that my credit card will be debited for all set-up charges and monthly in advance for the access fee. Once connected, I agree to abide by the terms and conditions found at i.net.au/agreement or available on hardcopy upon request. This form must be signed if submitting by hardcopy. The signatory must be at least 18 years of age.
 I Agree                     Signature                             Date