APPLICATION
For a .AC Domain Name |
Encode International Domain Names
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| Domain |
| 2. ASCII Domain Name |
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| 2b. Check this box if you do not want us to publish the phone, fax and e-mail for the Administrative contact in a whois query.
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| Organisation/Individual Using Domain Name |
| 3a. Organisation Name |
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| 3b. Street Address |
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| 3c. City/Town |
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| 3d. State/County/Region |
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| 3e. Postal/Zip Code |
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| 3f. Country |
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| Administrative Contact |
| If you enter the User ID of an existing Administrative Contact, you do not need to fill in 4b. to 4n. below. If you do so it will be ignored. |
4a. User ID (if known)
If entered, you do not need to fill in the details below. |
NIC-
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| - OR - |
| 4b. (I)ndividual (R)ole |
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| 4c. Name (Last, First) |
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| 4d. Organisation Name |
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| 4e. Street Address |
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| 4f. City/Town |
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| 4g. State/County/Region |
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| 4h. Postal/Zip Code |
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| 4i. Country |
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| 4j. Phone Number |
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| 4k. Fax Number |
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| 4l. E-Mail Address |
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| To allow you to amend and update your entry in the system, a password is required for the Administrative Contact. If you have entered an existing Administrative Contact, the password for that will be automatically used.
Please enter a password of your choice (up to 18 characters), then again in the confirmation box. |
| 4m. Password |
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| 4n. Password Confirmation |
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| Technical Contact |
| Leave this whole section blank if you want to use the details entered into the Administrative Contact above. |
5a. User ID (if known)
If entered, you do not need to fill in the details below. |
NIC-
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| - OR - |
| 5b. (I)ndividual (R)ole |
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| 5c. Name (Last, First) |
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| 5d. Organisation Name |
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| 5e. Street Address |
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| 5f. City/Town |
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| 5g. State/County/Region |
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| 5h. Postal/Zip Code |
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| 5i. Country |
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| 5j. Phone Number |
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| 5k. Fax Number |
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| 5l. E-Mail Address |
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| To allow you to amend and update your entry in the system, a password is required for the Technical Contact. If you have entered an existing Technical Contact, the password for that will be automatically used.
Please enter a password of your choice (up to 18 characters), then again in the confirmation box. |
| 5m. Password |
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| 5n. Password Confirmation |
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| Billing Contact |
| Leave this whole section blank if you want to use the details entered into the Administrative Contact above. |
6a. User ID (if known)
If entered, you do not need to fill in the details below. |
NIC-
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| - OR - |
| 6b. (I)ndividual (R)ole |
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| 6c. Name (Last, First) |
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| 6d. Organisation Name |
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| 6e. Street Address |
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| 6f. City/Town |
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| 6g. State/County/Region |
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| 6h. Postal/Zip Code |
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| 6i. Country |
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| 6j. Phone Number |
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| 6k. Fax Number |
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| 6l. E-Mail Address |
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| To allow you to amend and update your entry in the system, a password is required for the Billing Contact. If you have entered an existing Billing Contact, the password for that will be automatically used.
Please enter a password of your choice (up to 18 characters), then again in the confirmation box. |
| 6m. Password |
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| 6n. Password Confirmation |
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| Payment Details |
9a. Price
For one year registration |
NON - EU residents £60.00
Enter your EU company's VAT number (not UK):
EU residents and UK Companies
£60.00 + VAT @20%= £72.00 |
| 9b. Card Type |
PayPal Payment to PayPal@icb.co.uk within 7 days else deletion of Application
Visa
MasterCard |
9c. Name on Card
This must be as displayed on the card. |
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9d. Card Number
(e.g. 4949 1234 5678 9012) |
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| 9e. Expiry Date |
(mm/yy) |
9f. C.V.V.2 Code
(3-digit code located after the credit card number on the signature strip of Credit Card ) |
Find your C.V.V.2 Code (new window) |
9z. Account Number
If you have an Account, please enter those details instead |
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| Legal |
I agree to be bound by the Terms and Conditions (opens in new window).
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