HOME Channel 1 Domain Name Registration Request Form
CHANNEL 1® can handle the InterNIC registration process for you for a one-time fee of $25.00. You will need to pay our fee in advance by credit card.
Additionally, InterNIC (Network Solutions, Inc.) will charge you separately a registration fee of $70 for domain name ownership.
This registration fee covers the first two years of registration.
Your Requested Domain Name:  ________________________________________________
Begin name with letter; 22 letters/numbers max; dash only punctuation allowed; suffix .com for commercial,
.org for non-profit.

Your Organization Name: ____________________________________________________
Your Organization Address: _________________________________________________
Briefly describe your organization: ________________________________________
Your Administrative Contact: _______________________________________________
Does your Administrative Contact already have NIC handle? Y_______ N_______
If Yes, enter here: ________________________________________________________
Administrative Address: ____________________________________________________
Administrative Telephone (with Area Code): _______________Fax:_______________
Permanent Administrative E-mail address: ____________________________________
Other Administrative E-mail address: ________________________________________
Your Billing Contact: _______________________________________________________
Does your Billing Contact already have NIC handle? Y____________ N___________
If Yes, enter here __________________________________________________________
Billing Address: ____________________________________________________________
Billing Telephone (with Area Code): ______________________Fax:_______________
Permanent Billing E-Mail Address: ___________________________________________
Other Billing E-Mail Address: ______________________________________________
Please allow a few business days for registration to be confirmed. We cannot guarantee that your requested domain name is available, or that it will be assigned, until it is returned to us by the InterNIC Domain Registrar. We will notify you immediately if your requested domain name is unavailable. Please fill out credit card information below for $25 one-time Domain Name Registration handling fee.
Amex/Visa/MC:  __________-__________-__________-__________ Exp.Date: ________
Name as it appears on Card: ________________________________________________
Signature of Card Bearer: _______________________________ Date: ____________
Comments or Special Instructions: __________________________________________
InterNIC requires that all active domain names be linked to a primary and secondary name server. Unless you already have one or both, Channel 1 provides this link for you on your domain applications. For your information (not to be charged or paid for under this request) the fee for actively maintaining your Domain Name Service (DNS) on Channel 1 is $10/month. (DNS is included with the Channel 1 Virtual Server Website Account.)
Please return this Domain Name Registration Request application (form version 01.99) to:
Channel 1 Communications, 14 Arrow Street, Cambridge, MA 02138
Fax: 617-354-3100 Phone: 617-864-0100 E-Mail: sales@channel1.com

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