DOMAIN NAME REGISTRATION - ONLINE APPLICATION FORM

Domain Name Registrar (Australia) trading as Domain Registration Services is a wholly owned and operated Australian Domain Name Registrar officially accredited by the auDA (.au Domain Administration) to provide Australian consumers with domain name registration. By registering your domain name through this website you are dealing directly with the Registrar and will have total control over your domain name. For fast and efficient online registration of your domain name/s simply complete and submit the form below. An immediate response to all domain name registration requests guaranteed.

Requested Domain Names : 1. www.  - select - .com.au .net.au .org.au .asn.au .id.au .com .net .org .info .biz 2. www.  - select - .com.au .net.au .org.au .asn.au .id.au .com .net .org .info .biz 3. www.  - select - .com.au .net.au .org.au .asn.au .id.au .com .net .org .info .biz 4. www.  - select - .com.au .net.au .org.au .asn.au .id.au .com .net .org .info .biz 5. www.  - select - .com.au .net.au .org.au .asn.au .id.au .com .net .org .info .biz 6. www.  - select - .com.au .net.au .org.au .asn.au .id.au .com .net .org .info .biz Registrant Details (to whom the domain name/S will be registered) If registering a domain ending in .au, this section must be completed. Registrant Legal entity name is your business, company, or organisation name. Registrant Legal Entity Name: Registrant Contact Details Title: Mr Ms Mrs First Name: Last Name: Organisation: Postal Address: Suburb / City: Post Code: State: ---select--- Queensland New South Wales Victoria Australian Capital Territories Northern Territories Western Australia South Australia Tasmania OTHER Country: Please Select Your Country: United States Switzerland France Argentina Japan Australia Thailand Taiwan Canada United Kingdom Germany Albania Algeria American Samoa Andorra Angola Anguilla Antigua Armenia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Botswana Brazil British Virgn Is. Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Cent Afr Rep Chad Chile China Colombia Congo Congo Rep Cook Islands Costa Rica Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Rebublic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland French Guiana French Polynesia Gabon Gambia Georgia Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Nl. Antilles Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saipan Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Somalia South Africa South Korea Spain Sri Lanka St. Kitts & Nevis St. Lucia St. Vincent Sudan Suriname Swaziland Sweden Syria Tanzania Togo Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Is. U.S. Virgin Islands Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Yemen Zambia Zimbabwe Phone Number: Fax Number: Email Address: Your official domain name registration certificate together with a receipted tax invoice will be sent to this email address. Future renewal notices with regards to this domain name and important consumer alerts will also be sent to this email address. Please ensure you advise this office of any change to this email address in future to ensure we always hold your correct and current contact details. Email Address(2) optional: Pricing : .org.au $30 .com.au $127 .net.au $127 .asn.au $60 .com $99 .net $99 .id.au $59 .org $99 .info $99 .biz $99 Pricing refers to Australian Dollars, Australian residents add GST. Payment information Credit Card: VISA MASTERCARD BANK CARD AMERICAN EXPRESS DINERS Name on Card: Card Number: Expiry Date:  /  A receipted tax invoice will be forwarded to the email address you have inserted above Policies I warrant that I am eligible for this domain name licence in accordance with     the Domain name eligibility and allocation policy rules for open second level domains (2lds) I agree to the Domain Name Registration and Administration Services Agreement of Domain Registration Services and will be bound by the .au registrant licence agreement. IMPORTANT NOTICE: By submitting this application for a domain name, you confirm that you are eligible to hold the domain name set out in this application, and that all information provided in this application is true, complete and correct, and is not misleading in any way. If any the information is later found not to be true, or is incomplete, incorrect, or misleading in any way, or if you have submitted this application in bad faith, the domain name licence can be cancelled and you can permanently lose the use of the domain name.

Following submission of your domain name registration request you will receive notification that your order has been received. A confirmation notice regarding the outcome of your registration request will be forwarded to you via email. Upon successful registration of your domain name, you will receive an official domain name registration certificate together with a receipted tax invoice. Domain Name Registrar (Australia) Pty Ltd trading as Domain Registration Services is an official auDA (au Domain Administration) Accredited Registrar.

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Domain Name licences are issued for a two year term with the option to renew. Official Certificates of registration issued. Free Domain Renewal Reminder Service. All fees noted on this website are quoted in Australian dollars. No hidden costs No delegation fees No setup fees No administration fees Online Management

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