Request type
|
|
URL
|
|
Purpose and comments
(Explain the rationale for your request, including the selection of the domain name if applicable) |
|
Organisational information |
Organisation name
|
|
Communications manager
|
|
Approved by Agency Communications Manager
|
|
Postal address
|
|
Administrative contact |
Name
|
|
Position
|
|
Phone
|
|
Email
|
|
Technical contact |
Name
|
|
Position
|
|
Phone
|
|
Email
|
|
Customer help desk contact |
Name
|
|
Position
|
|
Phone
|
|
Email
|
|
Server |
DNS 1
|
|
DNS 2
|
|
DNS 3
(optional) |
|
Invoicing details |
Please acknowledge acceptance of the set-up fee of $53 (ex GST)
|
|
If this is a new account, please provide a billing address
|
|
For an existing Networking Tasmania Account, please provide your account number
|
|
Customer business contact and officer to receive invoices |
Name
|
|
Position
|
|
Postal address
|
|
Phone
|
|
Email
|
|
