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Estate
Planning Web Site Service
Have us buy
a new domain or transfer an existing domain or alter DNS
settings on your behalf
If you would like us
to register a new domain name for you OR help you transfer
your domain name to www.networksolutions.com
OR simply have us help you make some DNS changes (web
forwarding, email forwarding, etc.), please print this form,
fill it out, sign it and fax to 310-861-5126
(Internet Dept.) or 714-540-3085 (Main).
Though we will handle the technical aspects on your
behalf, you still own the domain name. For new domain name
purchases, we will buy your domain name through
www.networksolutions.com.
Current cost of owning a domain name is $35 per year,
sometimes with discounts for paying for multiple years.
How Can We Help?
(__) Buy and set up a new domain name for you at
www.networksolutions.com
(__) Transfer your existing domain name to www.networksolutions.com
(__) Help change the settings of an existing domain name for
you.
1. Domain Name
Your domain name is
the address you will give out to your clients and prospects.
It's like your phone number. This is NOT the same thing as
the email service provided by your Internet Service Provider
(ISP). Though you can certainly REDIRECT email sent to your
domain name (such as info@yourname.com) to your REAL email
accounts provided to you by your ISP (such as AOL,
Earthlink, etc.). You can use capital letters, but NOT
spaces. Special characters like !@#$%^&* are not
allowed. Consider using an abbreviation of your name or
company name as well, such as dpd.com or dpdlaw.com. Many
names are already registered, so please list your top three
choices below. Examples of good web addresses are:
bobsmithlaw.com
ohiolaw.net
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Buying A New
Domain
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First
Choice:
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____________________________________
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Second
Choice:
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____________________________________
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Third
Choice:
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____________________________________
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OR
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Already Own A
Domain Name
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Domain Name:
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____________________________________
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Registrar:
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____________________________________
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User
Name/ID:
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____________________________________
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Password:
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____________________________________
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2. Billing & Administrative
Contact
This is you and your
information. This will let you modify and control your
Domain Name.
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Full Name
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____________________________________
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Company
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____________________________________
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Street Address
1
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____________________________________
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Street Address
2
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____________________________________
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City
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____________________________________
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State
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____________________________________
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Zip
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____________________________________
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Phone
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____________________________________
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Fax
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____________________________________
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Is This Location
Your...
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(__) Home
(__) Office
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Email*
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____________________________________
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* This should be your REAL
email account (from Yahoo, AOL, Earthlink, etc.), NOT your
virtual one from your domain name.
3. Payment Information
To register your
domain name, InterNIC requires a credit card. Current cost
is $35 per year to own a domain name, sometimes with
discounts for paying for multiple years up front.
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Number of
Years:
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(__) Pre-Pay for
One Year
(__) Pre-Pay for Two Years
(__) Pre-Pay for Three Years
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Cardholder's
Name:
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____________________________________
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Card Type:
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(__) Visa
(__) Master Card
(__) American Express
(__) Discover
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Card Number:
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____________________________________
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Expiration (Month /
Year):
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____________________________________
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Card Billing
Address:
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(__) Check here if
same billing address as above,
otherwise fill in FULL address below
(street/city/state/zip):
____________________________________
____________________________________
____________________________________
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3 or 4 digit "Card
ID"
Last 3 digits
on back of card (Visa & MC),
or Floating 4 digits on front of card (Amex)
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4. Security
Registrars require
several levels of security in order to edit your domain name
information in the future (and in case you loose your
password, to confirm you are you). User ID can be anything,
but not the same as your name, your email, or your passwords
(a good choice is usually to abbreviate your name and append
some numbers). NOTE: If you already own your domain name,
and you are not transferring the domain name, you can skip
this section.
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Your
Birthday:
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____________________________________
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City You Were Born
In, OR:
Last 4 Digits of Your Social Security #:
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____________________________________
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User ID:
(8-12
characters, no spaces)
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____________________________________
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Password:
(8-12
characters, no spaces)
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____________________________________
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5. Authorization
By signing below,
you are authorizing us to use your credit card to register
your domain name. You still own the domain name, you
are simply authorizing us to purchase it and set it up on
your behalf.
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Signature
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____________________________________
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