dotFM Domain Name Registration Application

EMail: hostmaster@dot.fm

Fax  : +1.415.677.4025
Mail : dotFM - BRS Media
       760 Market St. Suite 958
       San Francisco CA 94102-2311

Authorization
0a.  (N)ew (M)odify (D)elete....:
0b.  Auth Scheme................:
0c.  Auth Info..................:

1.   Comments...................:

2a.  Complete .FM Domain Name...:
2b.  Registration Years.........: 2

Organization Using Domain Name

3a.  Organization Name..........:
3b.  Street Address.............:
3c.  City.......................:
3d.  State......................:
3e.  Postal Code................:
3f.  Country....................:

Administrative Contact
4a.  (I)ndividual (R)ole........:
4b.  Name (Last, First).........:
4c.  Organization Name..........:
4d.  Street Address.............:
4e.  City.......................:
4f.  State......................:
4g.  Postal Code................:
4h.  Country....................:
4i.  Phone Number...............:
4j.  Fax Number.................:
4k.  E-Mailbox..................:

Technical Contact
5a.  (I)ndividual (R)ole........:
5b.  Name (Last, First).........:
5c.  Organization Name..........:
5d.  Street Address.............:
5e.  City.......................:
5f.  State......................:
5g.  Postal Code................:
5h.  Country....................:
5i.  Phone Number...............:
5j.  Fax Number.................:
5k.  E-Mailbox..................:

Billing Contact
6a.  (I)ndividual (R)ole........:
6b.  Name (Last, First).........:
6c.  Organization Name..........:
6d.  Street Address.............:
6e.  City.......................:
6f.  State......................:
6g.  Postal Code................:
6h.  Country....................:
6i.  Phone Number...............:
6j.  Fax Number.................:
6k.  E-Mailbox..................:

Primary Name Server(s)
7a.  Primary Server Hostname....:
7b.  Primary Server Netaddress..:

Secondary Name Server(s)
8a.  Secondary Server Hostname..:
8b.  Secondary Server Netaddress:

Additional Name Server(s)
9a. Additional Server Hostname..:
9b. Additional Server Netaddress:

END OF AGREEMENT

dotFM - BRS Media
760 Market St Suite 958
San Francisco CA 94102-2311
Toll-Free..: 1.888.697.2860
Outside US.: 1.415.677.4027
Fax........: 1.415.677.4025