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


Buying A New Domain

First Choice:

____________________________________

Second Choice:

____________________________________

Third Choice:

____________________________________

OR

Already Own A Domain Name

Domain Name:

____________________________________

Registrar:

____________________________________

User Name/ID:

____________________________________

Password:

____________________________________




2. Billing & Administrative Contact
This is you and your information. This will let you modify and control your Domain Name.

Full Name

____________________________________

Company

____________________________________

Street Address 1

____________________________________

Street Address 2

____________________________________

City

____________________________________

State

____________________________________

Zip

____________________________________

Phone

____________________________________

Fax

____________________________________

Is This Location Your...

(__) Home
(__) Office

Email*

____________________________________

* 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.

Number of Years:

(__) Pre-Pay for One Year
(__) Pre-Pay for Two Years
(__) Pre-Pay for Three Years

Cardholder's Name:

____________________________________

Card Type:

(__) Visa
(__) Master Card
(__) American Express
(__) Discover

Card Number:

____________________________________

Expiration (Month / Year):

____________________________________

Card Billing Address:

(__) Check here if same billing address as above,
otherwise fill in FULL address below (street/city/state/zip):

____________________________________

____________________________________

____________________________________

3 or 4 digit "Card ID"
Last 3 digits on back of card (Visa & MC),
or Floating 4 digits on front of card (Amex)

____________




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.

Your Birthday:

____________________________________

City You Were Born In, OR:
Last 4 Digits of Your Social Security #:

____________________________________

User ID:
(8-12 characters, no spaces)

____________________________________

Password:
(8-12 characters, no spaces)

____________________________________




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.

Signature

____________________________________