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