1.
VISP Details
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2.
Contact Details
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Title:
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Email
Address:
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First
Name:
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Daytime Tel.:
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Last
Name:
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* |
Evening Tel.:
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Fax
Number:
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3.
Company Information
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VISP
Service Name:
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VISP
Domain:
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4.
Postal Address
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5.
Payment Details
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Address:
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* |
Terms of
Payment: In Advance
Payment
Method:
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Annual
Charges: £50.00 ex.VAT
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Card
Type:
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Postcode:
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Card
Number:
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Expiry Date:
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Issue
Number:
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6.
Registration of a New Domain
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1st
Preference:
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* Official Domain Records to show registered owner's name, address and postcode as:
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2nd
Preference:
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3rd
Preference:
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7.
Security Information - Pertaining to the Wholesale Domain
administrator
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Date
of Birth:
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Mother's Maiden Name:
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8.
Your Comments
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