**************** Please DO NOT REMOVE Version Number ***************
Template Version Number: 1.3
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Instructions for filling in this form can be found at http://www.za.net/instructions.txt
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1a. Domain Name.....................:
Request type is NEW, MODIFY, MANUAL-MODIFY or DELETE
1b. Request Type....................:MODIFY
Organisation
2a. Name............................:
2b. Street Address..................:
2c. City............................:
2d. Post Code.......................:
2e. Country.........................:
Administrative Contact
3a. Name and Surname................:
3b. Organisation Name...............:
3c. Street Address..................:
3d. City............................:
3e. State or Province...............:
3f. Postal Code.....................:
3g. Country.........................:
3h. Phone Number....................:
3i. Fax Number......................:
3j. Email Address...................:
Technical Contact
4a. Name and Surname................:
4b. Organisation Name...............:
4c. Street Address..................:
4d. City............................:
4e. State or Province...............:
4f. Postal Code.....................:
4g. Country.........................:
4h. Phone Number....................:
4i. Fax Number......................:
4j. Email Address...................:
Primary Name Server
5a. Primary Server Hostname.........:
5b. Primary Server IP Address.......:
Secondary Name Server(s)
6a. Secondary Server Hostname.......:
6b. Secondary Server IP Address.....:
7a. Secondary Server Hostname.......:
7b. Secondary Server IP Address.....:
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The completed form should be mailed to auto-dbm@za.net
By submitting this form you agree to the terms and policies at http://www.za.net/policy.html
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