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Domain Name Application Form

Domain Name * :
   
     
Company Name* : (Put NA if not Applicable)
Contact Person* :
Address 1* :
Address 2 :
City :
Country* :
State :
Postal Code* :
Telephone No.* :
Mobile No.* :
     
User Name* :
Password* :
Confirm Password* :
     
Name Server 1 : (Fill in only if using own webhost)
Name Server 2 : (Fill in only if using own webhost)
     

 

 

 

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