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INSTRUCTIONS: This form should be sent to the following email
address: orders@enom.com

We strongly suggest you establish an email Password separate from
your eNom account.  To establish a separate email password, please 
log in to your account, click on "help" and then "eNom Support Center".
In the Support Center, click the "Submit a Ticket" tab. In the 
description, include your login name and desired email password.

By default, we will use the billing information that you have
provided in your account. You can also specify a Registrant,
Technical, or Auxiliary Billing contact.

Only the Authorization and Domain Name sections are required. All
others fields are optional. If the Registration Period is left
blank, the default registration will be the same as your eNom account.

AGREEMENT TO BE BOUND. By completing this form and emailing to
eNom, you agree to the Terms and Conditions as presented to you at
the time of account creation.

The Terms and Conditions are located at:
http://www.enom.com/help/HostTerms.asp

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[eNom Domain Name Registration 1.1] -- IMPORTANT: Do NOT remove this line.

Authorization
0a.  (N)ew........................: N
0b.  LoginID......................:
0c.  Password.....................:
0d.  Confirmation Email Address...:

Domain Name
1a.  Complete Domain Name.........:
1b.  Registration Period(1-10yrs).:
1c.  Domain Password .............:
1d.  Auto-Renew Domain (Y/N) .....:
1e.  Lock Domain (Y/N) ...........:

Registrant Contact
2a.  Organization.................:
2b.  Name (Last, First)...........:
2c.  Street Address...............:
2d.  City.........................:
2e.  State........................:
2f.  Postal Code..................:
2g.  Country......................:
2h.  Phone Number.................:
2i.  Fax Number...................:
2j.  E-Mailbox....................:

Technical/Zone Contact
3a.  Organization.................:
3b.  Name (Last, First)...........:
3c.  Street Address...............:
3d.  City.........................:
3e.  State........................:
3f.  Postal Code..................:
3g.  Country......................:
3h.  Phone Number.................:
3i.  Fax Number...................:
3j.  E-Mailbox....................:

Auxiliary Billing Contact
4a.  Organization.................:
4b.  Name (Last, First)...........:
4c.  Street Address...............:
4d.  City.........................:
4e.  State........................:
4f.  Postal Code..................:
4g.  Country......................:
4h.  Phone Number.................:
4i.  Fax Number...................:
4j.  E-Mailbox....................:

eNom Name Servers
5a.  Use eNom Name Servers (Y/N)..:

Name Servers (if not using eNom's)
6a.  Server Hostname..............: 
6b.  Server Hostname..............: 
6c.  Server Hostname..............: 
6d.  Server Hostname..............: 
6e.  Server Hostname..............: 
6f.  Server Hostname..............: 
6g.  Server Hostname..............: 
6h.  Server Hostname..............: 
6i.  Server Hostname..............: 
6j.  Server Hostname..............: 
6k.  Server Hostname..............: 
6l.  Server Hostname..............: