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