com.au Domain Name Application Form
Help
You can use this form to apply for a domain name. If you are also ready to host this domain name, then please complete the delegation form
after
you have completed this one (by clicking on "Delegate" at the bottom of the page).
1. Application Information
Your email address:
Domain Name:
.com.au
Service Level:
Top:
Premium:
Standard:
Billing Contact:
My email
Admin contact
NIC handle:
NIC handle:
2.1 Business Name Details
Fill in this section if you have a registered business name. Please complete all fields.
Business Name Details:
Business Name:
State:
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
RBN:
Proprietor:
Sole Trader
Partnership
Company
Other
2.2 Company Details
Fill in this section if you have a company. If you are applying for a domain name for a trading name, also complete the above section.
Company Details:
Company Name:
ACN:
2.3 No Business or Company Registration
Fill in this section if the application is for an organisation without business or company registration.
No business or company registration:
Organisation Name:
Organisation Type:
Incorporated Association
Financial Institution
Statutory Corporation
Registered Superannuation Fund
Other (explain below)
Explain organisation type (include any registration info):
3. Postal Address Information
This should be the registered place of business.
Postal Address:
Street Address:
Suburb/City:
State:
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
Post code:
4. Administrative Contact
If the admin contact already has a NIC handle, put it here.
Admin NIC Handle:
Complete this section to create a new admin NIC handle.
Create Client NIC Handle:
First Name:
Surname:
Their Position:
Their email address:
Telephone:
Fax:
5. Other
com.au
Names
Do the organisations listed above have other com.au domain names?
Other
com.au
Names
:
Other
com.au
Names:
Yes:
No
List Other Names:
Explain Other Names:
6. Market Research
How did you find us:
Web Search
Yellow Pages
Word of Mouth
Small Business Victoria
Australian Personal Computer
Business Expo 98
Interact
Internet World
Newspaper
Internet Service Provider
Lawyer
Accountant
Business Associate
Other
We welcome
comments
on this document.
© Internet Names Australia 1998