Domain Registration Form

For ICBS to register your domains use the form below.

Note: Registrations are confirmed only after it is made and confirmed. It is possible that domains are reported as available and when registering it is not available. This can happen because very often the pending registrations are not flagged when you search the domain name registry; but the system do check for any pending registration requests. It is also possible that the domains were registered before you could register it. ICBS, Inc. cannot be responsible if we were unable to register the domain you have requested.

Please check the information below for accuracy. If any information is inaccurate, there will be additional delays in registering your domain.

 

Complete Domain Name
(Include .com, .net etc.
eg., yourcompany.com)

You can register multiple domains
if all domains are to be registered
to the same business and contact
as listed below. Otherwise, use a
separate form for each new domain.

Organization Using Domain Name
Organization Name
Street Address Line 1
Street Address Line 2
City
State
Zip
Country

Administrative Contact
Name (Last, First)
Organization Name
Address Line 1
Address Line 2
City
State
Zip
Country
E-mail
Tel
FAX

Technical Contact
Name (Last, First)
Organization Name
Address Line 1
Address Line 2
City
State
Zip
Country
E-mail
Tel
FAX

Billing Contact
Name (Last, First)
Organization Name
Address Line 1
Address Line 2
City
State
Zip
Country
E-mail
Tel
FAX
Name Server Information
(You can skip the name server info
If you are using ICBS, Inc, for web
hosting)

Prime Name Server
Primary Server Hostname
Primary Server Netaddress

Secondary Name Server(s)
Secondary Server Hostname
Secondary Server Netaddress
Secondary Server Hostname
Secondary Server Netaddress
Registration Period (1-10 yrs)

Payment Information
Credit Card Type
Account Number
Expiration Date: Month Year
Name on Credit Card
Billing Address1
Billing Address2
City
State
Zip or POstal Code
Country 
     
If you prefer you can print this form and Fax it to 330-733-4380
or click on the Submit button below for electronic processing.
No information is sent until you click on the button below marked submit.