New Modify Delete Renew Transfer
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Domain Name Registration Kuwait □ New □ Modify □ Delete □ Renew □ Transfer
□ International Domain (.com, .net, .org)
□ Local Domain (.com.kw, .net.kw, .org.kw, .edu.kw and .gov.kw) per year, minimum of Two Years
Domain Name required *: ______(Please make sure that the Domain Name you have selected is available or ask our representative to check it for you).
* Subject to availability.
□ Individual Customer □ Company
1. Applicant
Name: Organization Address: Email Address: Phone: Fax: Mobile/Pager:
2. Administrative Contact (This part shall be filled by AGIP)
Organization Name: Name: Address: Phone: Fax: Mobile/Pager:
3. Billing Contact (If the information below is same as provided above, please write: "Same as Above" in the first field only)
Name: Organization Address: Email Address: Phone: Fax: Mobile/Pager: 4. Technical Contact (If the information below is same as provided above, please write: "Same as Above" in the first field only)
Name: Organization Address: Email Address: Phone: Fax: Mobile/Pager:
5. DNS Servers: Use Qualitynet DNS Server I will use my own DNS Server
6.
Primary DNS: IP Address:
Secondary DNS: IP Address: