-------------------------------- Start of form -------------------------------- PART 1: REGISTRATION INFORMATION 1. Action to be taken (register new domain, modify data, delete domain) # (M) modify domain information, # (D) delete domain information Specify M or D above -----------------> ________________ 2. Thirdlevel domain name (chose only *one* of *.AC.YU, *.CO.YU, *.ORG.YU): __________.AC.YU __________.CO.YU __________.ORG.YU __________.EDU.YU PART 2: ORGANIZATION INFORMATION Organization name: _______________________________ Organization address: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ PART 3: ADMINISTRATIVE CONTACT Name (first, last) _______________________________ Organization _______________________________ _______________________________ Street address _______________________________ Postal code _______________________________ City _______________________________ Country _______________________________ Phone number _______________________________ Fax number _______________________________ E-mail address _______________________________ PART 4: TECHNICAL CONTACT Name (first, last) _______________________________ Organization _______________________________ _______________________________ Street address _______________________________ Postal code _______________________________ City _______________________________ Country _______________________________ Phone number _______________________________ Fax number _______________________________ E-mail address _______________________________ PART 5: PRIMARY DOMAIN NAME SERVER Primary server host name _______________________________ Primary server IP address _______________________________ PART 6: SECONDARY DOMAIN NAME SERVER Secondary server host name _______________________________ Secondary server IP address _______________________________ PART 7: ADDITIONAL DOMAIN NAME SERVER INFORMATION Additional server host name _______________________________ Additional server IP address _______________________________ PART 8: ADDITIONAL DOMAIN NAME SERVER INFORMATION Additional server host name _______________________________ Additional server IP address _______________________________ PART 9: INTERNET SERVICE PROVIDER (MANDATORY !!!) Organization name _______________________________ Contact person _______________________________ Address _______________________________ Phone number _______________________________ Fax number _______________________________ E-mail address: _______________________________ --------------------------------- End of form ---------------------------------