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:  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: RBN:
Proprietor: 
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:
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: 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: 
List Other Names:
Explain Other Names:
6. Market Research
How did you find us:

   
We welcome comments on this document.
© Internet Names Australia 1998