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New Domain Request Form

If you need to register a new Domain name, please fill out this form and then press the submit button. If you need to transfer an existing domain name to DSL-Only, click here.

Organizational Information (Legal Owner of Domain Name)

Domain name:

Does this domain need to be registered:

Organization or Name Using Domain Name:

Street Address:

City:

State:

Zip Code:

Administrative Contact Information (Individual or Role responsible for answering legal questions about Domain Name)

NIC Handle:

Name:

Phone number:

Fax Number:

Email address:

Street Address:

City:

State:

Zip Code:

Technical Contact Information (Individual or Role responsible for Interacting with InterNIC) We'll supply this info.

Billing Contact Information (Individual or Role responsible for paying Domain Name fees with InterNIC)

Check if same as Administrative Contact Above

NIC Handle:

Name:

Phone number:

Fax Number:

Email address:

Street Address:

City:

State:

Zip Code:

Domain Setup Information (Info we need to set your domain up on our systems)

DSL-Only Account Username:
Number of IP addresses on your DSL Circuit:
1st IP Address:	DNS(Machine) Name:
2nd IP Address:	DNS(Machine) Name:
3rd IP Address:	DNS(Machine) Name:
4th IP Address:	DNS(Machine) Name:
5th IP Address:	DNS(Machine) Name:
6th IP Address:	DNS(Machine) Name:
7th IP Address:	DNS(Machine) Name:
8th IP Address:	DNS(Machine) Name:

Note: Virtual Servers and aliases may have additional setup & monthly charges associated with them.

WWW Server (DNS CNAME Record) points to:
If Other Please Explain:
FTP Server (DNS CNAME Record) points to:
If Other Please Explain:
Mail Server (DNS MX Record) points to:
If Other Please Explain:
Forward Primary User's (billing) mailbox to:
If Other Please Specify Mailbox to forward to

If you want mail aliases, please list (* wildcards apply):

Name@Domain.com	Aliased to	Name@DSL-Only.net
Alias #1(free):
Alias #2:
Alias #3:
Alias #4:
Other Special Requirements:

Please take a moment to re-read your application. If you send us incorrect information, it could take a while for your application to be processed. Once you are sure the information is currect, click on the "Submit" button to send your new domain application to us so we canget the ball rolling.