******* Please DO NOT REMOVE Title ********
INT Domain Registration Template V1.4

This registration form should be used for any international domain names including .com, .org, .net, .info and .biz. By submitting this form you agree to Servicecentre.co.uk Ltd's terms and conditions as listed on our web site at http://www.servicecentre.co.uk/reseller/. If you are a third party acting on behalf of the Registrant, by submitting this for you certify that you have informed the Registrant and have confirmed that they understand and have agreed to Servicecentre.co.uk Ltd's terms and conditions as listed on our web site at http://www.servicecentre.co.uk/tandcs.html

(You may apply for more than one domain name per email by repeating the "Registrant's Details" section. Please do not alter, add or remove field names.)
(.com, .org and .net, .info and .biz and other international domains)

Registrant's Details 
--------------------
Domain Name: 
Period: 2

Owner First Name: 
Owner Last Name: 
Owner Organisation: 
Address (line 1): 
Address (line 2): 
City: 
County/Region: 
Postcode: 
Country: UK
Phone No: +44 (0) 
Fax No: +44 (0) 
Primary Nameserver Name: ns0.servicecentre.co.uk
Primary Nameserver Netaddress: 217.158.74.10
Secondary Nameserver Name: ns1.servicecentre.co.uk
Secondary Nameserver Netaddress: 217.158.74.11
 
Names can be registered from one to ten years, the default is 2.
The name will be registered to and owned by the name given in the "Owner First Name" and "Owner Last Name" field unless the "Owner Organisation" is given, in which case it will be registered to that company or business.
You should register the name for the end-customer as changing registrant is a very involved process.
Please give the domain name registrant's address as fully as possible.
The second address line, the organisation name and the fax number are optional - ALL OTHER FIELDS ARE COMPULSORY
Please change the nameserver details if you want to hold the name elsewhere. If you do not currently have these details at hand or if you are unsure of what to do, then please leave them as they are and we can change them later if necessary.
Please ensure that the domain name requested is correct as we cannot alter or revoke the registration once submitted. Incorrect or unwanted names will be charged for in full.


Reseller Details
----------------
Reseller ID: New Reseller
Business Name: 
Contact Name: 
Email Address: 
Address (line 1): 
Address (line 2): 
City: 
County: 
Postcode: 
Country: UK
Phone No: 
Fax No: 
Special Instructions: 

*** Please send the completed form to domains@servicecentre.co.uk ***
If you include a reseller ID, you need not complete the other fields.
The details given in this section will be used for billing purposes.
If you require email forwarding or web space, please give the details in the "Special Instructions" field.
Please note that our terms are 7 days, after which time unpaid domains may be suspended without further notice.