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Domain name request form

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

Name Server

NS 1
NS 2
NS 3
(optional)

Invoicing details

Please acknowledge acceptance of the set-up fee for all domain requests (limit of 1 active domain per request and unlimited inactive domains) $53 (ex GST) and ongoing annual registration fee (active and inactive domain names) $8.67/domain name (ex GST)
Active domain names are linked to an active website. Inactive domain names may be registered to mitigate risks of cybersquatting, brand reputation protection or as placeholders for known future initiatives. Inactive domain names are not linked to an active website. Please see your Agency Communication Manger if you require direction or advice on registration of inactive domain names.

For an existing Networking Tasmania Account, please provide your account number

Customer business contact and officer to receive invoices (if new to NetTas)

Name
Position
Postal address
Phone
Email