Hello, Joey Lindstrom.  I wish to register a domain with you.

The domain name is:

_____________________ .INFO

My domain is (check one):

___ new
___ existing (transfer)
___ existing (renew, already registered with you)

Registration/renewal/transfer period requested:

___ years (minimum 2 if new, maximum 10)


Fill out this section ONLY if you already have an existing profile with
OpenSRS/Tucows (which you manage at http://manage.opensrs.net)

I have an existing domain profile, and I would like you to use the
contact information already set up with one of the domains in that
profile.  The domain to use as a template is:

Domain:
Username:
Password:

I understand that if this is a new or transfered domain, this domain
will be added to my existing profile.



Fill out this section ONLY if the previous section does not apply

I want you to use the following information when setting up this
domain.  I will fill out the OWNER section at a minimum.  If any of the
other sections are to be set the same as OWNER or another section, I
will so indicate in the "First name:" field of that section.

OWNER
First name:
Last name:
Company/Organization (if applicable):
Street Address:
City:
Province/State:
Country:
Postal/ZIP code:
Phone number:
Fax number (optional):
Contact email address:

ADMINISTRATIVE CONTACT
First name:
Last name:
Company/Organization (if applicable):
Street Address:
City:
Province/State:
Country:
Postal/ZIP code:
Phone number:
Fax number (optional):
Contact email address:

BILLING CONTACT
First name:
Last name:
Company/Organization (if applicable):
Street Address:
City:
Province/State:
Country:
Postal/ZIP code:
Phone number:
Fax number (optional):
Contact email address:

TECHNICAL CONTACT
First name:
Last name:
Company/Organization (if applicable):
Street Address:
City:
Province/State:
Country:
Postal/ZIP code:
Phone number:
Fax number (optional):
Contact email address:


NAME SERVERS
(if unsure what to put, leave blank for now)

Primary name server name:
Primary name server IP:
Secondary name server name:
Secondary name server IP:
(add additional nameservers if desired)


I am remitting $20 USD or $30 CAD per year desired.  I will be
remitting this via (check one):

___ PayPal
___ Money order sent via postal mail