Registrar Information from VeriSign, Inc.

I. Registrar Information

Type of Registrar	More Info Type of Registrar: If you are interested in offering both COM/NET and ccTLD registrations, you only need to fill this form out ONCE. In the "Comments" area (Section VI), tell us which registrations you plan to offer along with any additional products you would like to offer.
Corporate Name
Address
City
State/Providence
Zip/Postal Code
Country
Telephone Number	(Please include country code.)
Facsimile Number

II. Administrative E-Mail Addresses

Administrative 1 E-Mail Address	More Info E-mail account designated by the Registrar to receive messages such as Low Credit Balance. Please provide an address that is actively monitored.
Administrative 2 E-Mail Address	More Info E-mail account designated by the Registrar to recevie messages such as Domain Transfer notification. Please provide an address that is actively monitored.

III. Security Pass Phrase

Phrase

More Info

When your staff requests the performance of administrative actions, our Customer Service Representatives authenticate them using a security pass phrase. For your protection, we cannot perform changes without this authentication. Please be sure that all authorized Registrar contacts are informed of this pass phrase prior to calling the Registry. Please protect your pass phrase and change it if authorized contacts change.

IV. Contacts

Primary Administrative Contact (must be 24 x 7) More Info The Primary Administrative Contact is your principal representative. He or she should hold a managerial- or officer-level position, and should be empowered to speak and act on behalf of your company. We will take direction from your Primary Administrative Contact on the following issues: - Account-related - Legal - Invoice/Billing - Credit - Requirement - Technical/System If you have additional Administrative Contacts, please provide their information in the Additional Contacts section and list them in the order that you would like us to use for urgent notifications.
Job Title
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Chief Executive Officer More Info The Executive Contacts should include Chief Executive Officer, President, and attorney or legal representative. Check here if the main contact information is the same for this section.
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
President Check here if the main contact information is the same for this section.
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Attorney or Legal Representative Check here if the main contact information is the same for this section.
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Primary Technical Contact (must be 24 x 7) More Info The Technical Contact is your technical representative who should possess engineering or computer related knowledge, and should be authorized to act on your behalf concerning technical systems and operational issues. If you have multiple Technical Contacts, please provide them in the Additional Contacts section in the order that you would like us to use for urgent notifications. Check here if the main contact information is the same for this section.
Job Title
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Billing Contact More Info The Billing contact is your finance or billing representative. He or she should be authorized to resolve financial, credit, and billing issues. The Billing Contact is responsible for ensuring prompt responses to Registry invoices. Check here if the main contact information is the same for this section.
Job Title
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Primary Notification Contact More Info The Primary Notification Contact is your representative who should be sent any official notifications provided under the Registry-Registrar Agreement. Check here if the main contact information is the same for this section.
Job Title
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Secondary Notification Contact More Info The Secondary Notification Contact is your representative who should be copied on any official notifications provided under the Registry-Registrar Agreement. This contact may also be a law firm if you so elect. Check here if the main contact information is the same for this section.
Job Title
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Transfer Dispute Contact More Info The Transfer Dispute Contact is your representative who should be contacted for any issues relating to transfer disputes. This contact must be consistent with the Transfer Dispute Contact that you have provided to ICANN. Check here if the main contact information is the same for this section.
Job Title
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number
Marketing Contact More Info The Marketing Contact is your representative who is responsible for your marketing efforts and should be provided information relating to VeriSign marketing programs. Check here if the main contact information is the same for this section.
Job Title
First Name
Last Name
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Telephone Number
Facsimile Number

V. System Information

1. Registrar Whois Server Name	More Info Please provide the name of your Whois server (e.g., whois.registrar.com). This server name will be visible to all users of the Registry's Whois service and will be one of the primary means of referral to your company. This server must be operational before you go live as an operational Registrar.
2. Registrar Web Site URL	More Info Please provide the name of your primary business web server (e.g., www.registrar.com). This server name will be visible to all users of the Registry's Whois service and will be one of the primary means of referral to your company. This URL must be operational before you go live as an operational Registrar.
3. Registrar OT&E Client Subnets	More Info (Opens in separate window)
3. Registrar OT&E Client Subnets	(Optional)
	(Optional)
4. Registrar Production Client Subnets	More Info (Opens in separate window)
	(Optional)
	(Optional)
5. Registrar Web Tool Subnets	More Info (Opens in separate window)
	(Optional)
	(Optional)
	(Optional)
	(Optional)
6. SSL Certificate Common Name	More Info Also known as the URL, the common name is the fully qualified domain name used for DNS lookups of your server (such as www.bookstore.com). This information is used by browsers to identify your Web site. If you change your common name, you will need to request another Digital ID. Client browsers connecting to your host will check for a match between your Digital ID's common name and your URL. Do not use wildcard characters (such as *, ?, and others), IP addresses, or Port numbers in this field. Do not include "http://" or "https://" in your common name. The SSL Certificate Common Name will be required in the testing environment.
	(Optional)

VI. Comments

Please note any special instructions or additional information
More Info

If you are interested in offering both COM/NET and ccTLD registrations, please make a note in the "Comments Section." Please list the additional products you would like to offer.

List any special instructions our staff should follow when attempting to reach your contacts. For example, "When calling the second administrative contact, if a fax machine answers, do not hang up. The phone line will switch on automatically."

VII. Additional Contacts

Additional Contact 1 More Info Please list any additional Administrative or Technical Contacts in the order they should be contacted in the event of emergency.
Type of Contact
Job Title
First Name
Last Name
Telephone Number
Facsimile Number
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Additional Contact 2 More Info Please list any additional Administrative or Technical Contacts in the order they should be contacted in the event of emergency.
Type of Contact
Job Title
First Name
Last Name
Telephone Number
Facsimile Number
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country
Additional Contact 3 More Info Please list any additional Administrative or Technical Contacts in the order they should be contacted in the event of emergency.
Type of Contact
Job Title
First Name
Last Name
Telephone Number
Facsimile Number
E-mail Address
Address
City
State/Province
Zip/Postal Code
Country

Registrar Information Form