Domain Name Registration/Reservation Form
Domain Name Registration Application Form for the .ps Domain
Application for: ( Registration ( Renewal ( Modification
Renewal Period: ( (1) One year ( (3) Three years ( (10) Ten years
|Certified Registrar |
|Name: Lulu's Company For Telecom & IT. |PNINA Certification No. |
|Payment Method: θ Bank Deposit (Attach Slip) θ Deduct from my Credit Line |
|Applicant (Domain Owner) |
|Name: |Email: |
|Address: |Tel: |
|P.O. Box |Mobile: |Fax: |
|Administrative Contact |
|Name: |Title: |
|Address: |
|Mobile: |Tel: |
|Fax: |Email: |
|Technical Contact |
|Name: |Title: |
|Address: |
|Mobile: |Tel: |
|Fax: |Email: |
|Domain Name |Second Level Domain |
| |θ ps θ com.ps θ org.ps θ net.ps |
| |θ gov.ps θ sec.ps θ edu.ps θ plo.ps |
|Other Choices if first choice is not available: |
|1- 2- 3- |
|Domain Name Servers (Fully Qualified Host Name) |
|Primary Name Server: |IP Address: |
|Secondary Name Server: |IP Address: |
|Third Secondary Servers: |IP Address: |
|By signing this registration form, I admit that I have read, understood and agreed to be bound by Registration Policies and |
|Procedures for Registering domains under the .ps ccTLD document and the terms and conditions set in that document and PNINA |
|By-laws which can be found at PNINA website (pnina.ps). I confirm that all the information entered into this form is |
|correct and I undertake to advice PNINA about any change. |
|Certified Registrar |
|Name |Authorized Signature/Stamp |Date |
| | | |
|Applicant |
|Name |Authorized Signature/Stamp |Date |
| | | |
|For PNINA Use Only |
|Serial No: |PNINA Staff Name: |
|Date: |Time: |Status: θ APPROVED θ REJECTED |
|Comments: |
| |
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