APPLICATION FORM

DOMAIN NAME REGISTRATION

Please fill in this application form carefully and ensure you provide correct, complete and accurate information. By registering
the Domain Name(s) listed here in the application form you will be entering into a registrant agreement with ITRDN Technologies
Ltd. and a Domain Name License with the terms and agreement. Should you not agree to any of the conditions in the registrant
agreement or the Domain Name License, do not proceed with the registration. A copy of the registrant agreement and the
Domain Name License is attached to this form and also available at our website
http://www.itrdntechnologies.com/domainregistrationterms.
TYPE OF SERVICE
New Registration Renew Transfer Modify Contact Terminate
One years Two years Three years Four years Five years

CHOICE DOMAIN NAME(S)
1. 5.
2. 6.
3. 7.
4. 8.
By submitting this application for a domain name, you hereby confirm that you are eligible to hold the domain name set out in
the application, and that all information provided in this application is true, complete and correct, and are not misleading in any
way. If any information is later found not to be true, or is incomplete, incorrect, or misleading in any way, or if you have
submitted this application in bad faith, the domain name license shall be cancelled and you shall permanently lose the use of the
domain name. Also you agree to the terms & conditions attached with this application form and/or available on web site
http://www.itrdntechnologies.com/domainregistrationterms.
REGISTRANT DETAILS
Name:
Address:
Email: P.O.Box:
Telephone: Mobile: Fax:
State: Country:

ADMINISTRATIVE DETAILS
Name:
Address:
Email: P.O.Box:
Telephone: Mobile: Fax:
State: Country:

TECHNICAL DETAILS
Name:
Address:
Email: P.O.Box:
Telephone: Mobile: Fax:
ITRDN TECHNOLOGIES LTD

State: Country:

BILLING DETAILS
Name:
Address:
Email: P.O.Box:
Telephone: Mobile: Fax:
State: Country:

CUSTOMERS REPRESENTATIVE
Name:
Address:
Email: Phone:
Signature: Date:

NAME SERVER DETAILS
Primary Name Server
Host Name: IP Address:
Secondary Name Server
Host Name: IP Address:

Requirements/Documentation
Mean of valid identification
Business Registration Certificate

Office Use Only
Request Number: Account/Customer ID:
Hosting Plan: Payment Mode:
Domain Registration Date: Account Officer:

Please note that domain name registration and hosting are renewable yearly and base on subscription tenure, hence ITRDN
Technologies Ltd. will not be responsible for failure to renew the domain name before expiration. Customer should note that
domain name can be taken over by another individual or entity in the event that the existing domain name owner fails to renew
and the domain expires. Domain registration application is subject to international and Nigeria regulations hence ITRDN
Technologies Ltd. as a Registrar reserves the right to reject application for domain name registration that do not comply with set
policies without recourse to legal suits.