This form is required to register a domain name in The ...



This form is required to register or modify a domain name in The Bahamas top-level Internet domain (.bs). A separate form should be completed for each domain name to be registered. Completed registration forms should be delivered to:

BSNIC

Office of Information Technology

University of The Bahamas

P.O. Box N4912

Nassau, Bahamas

The application may also be e-mailed to the following address: bsadmin@ub.edu.bs. Submission of this registration form signifies your agreement with the Terms and Conditions of Registration as published on the Web site register.bs .

|Requester: | |

|Application Date: | |

|Subject: | |

|Current E-Mail: | |

Type of Request: New Domain Modify Existing Domain Delete Domain

(Double-click the appropriate box to insert a check mark)

Complete Domain Name:

|Domain Registrant | |Technical Contact |

|Company: | | |Name (Last, First): | |

|Address: | | |Company: | |

|P.O. Box: | | |Address: | |

|City: | | |P.O. Box: | |

|State: | | |City: | |

|Postal Code | | |State: | |

|Country: | | |Postal Code/Zip: | |

|Classification: | | |Country: | |

|TIN: | | |Phone: | |

| | | |Fax: | |

| | | |E-Mail: | |

|Administrative Contact | |Billing Contact |

|Name (Last, First): | | |Name (Last, First): | |

|Company: | | |Company: | |

|Address: | | |Address: | |

|P.O. Box: | | |P.O. Box: | |

|City: | | |City: | |

|State: | | |State: | |

|Postal Code/Zip: | | |Postal Code/Zip: | |

|Country: | | |Country: | |

|Phone: | | |Phone: | |

|Fax: | | |Fax: | |

|E-Mail: | | |E-Mail: | |

|Primary Name Server |Hostname: | |IP Address: | |

|Secondary Name Server |Hostname: | |IP Address: | |

| |Hostname: | |IP Address: | |

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