Complete this form to transfer an existing domain
name to urbancom.net. If the domain does
not exist or has expired, complete a New
Domain Name Registration Form.
SETUP FEES: Domain setup cost is $100.00. You must arrange payment by one
of the following:
By: _______________________________________(Name)
Its:_______________________________________(Title)
Organization (Registrant) Information
Organization Name:
Organization Address:
City, State & Zip:
Phone Number:
Fax Number:
What products or services does your organization offer:
What do you plan to use the domain for:
Contact Information
Administrative Contact:
Name (last, first):
Organization:
Street Address:
City, State & Zip:
Phone Number:
Fax Number:
E-Mail:
Billing Contact:
Same as Administrative Contact or complete the following:
Name (last, first):
Organization:
Street Address:
City, State & Zip:
Phone Number:
Fax Number:
E-Mail:
Current ISP handling this domain:
Does the domain currently have mail service i.e. mail.yourdomainname?
YES
NO
Does the domain currently have www service i.e. www.yourdomainname?
YES
NO
Does the domain currently have ftp service i.e. ftp.yourdomainname?
YES
NO
If there are any additional services running on this domain, please list them here:
I am
mailing a check
Call me
to get my credit card number
The undersigned hereby represents and warrants to Urban Communications, Inc.,
an Illinois Corporation, that he represents the applicant and submits this
application with the applicant's approval, and that the domain name the
applicant is requesting tranferred does not infringe upon, conflict with, or
otherwise violate the rights of others, including, without limitation, any
service mark, trademark, trade name, and/or copyright. Applicant agrees
that it shall indemnify, defend, and hold harmless Urban Communications, Inc.
and its officers, directors, employees, agents, and shareholders from and
against any costs, expenses (including, but not limited to, attorneys' fees and
expenses), losses, damages, suits, claims, or liabilities arising out of, in
connection with, or relating to the applicant's use of the subject domain name.
Urban Communications, Inc.'s application to transfer the subject domain
name is done with the express approval of the applicant. The undersigned
also has read the Terms of Service and
the applicant agrees to operate the domain in accordance with those terms.
IMPORTANT: You may submit this form by online
processing, but a signed copy must be received at the offices of Urban
Communications, Inc. within 48 hours. You should print a copy of the
application at this time by pressing the "PRINT" button on your browser.
If you are not able to print a copy of this application please note this and a
completed copy will be mailed or faxed to you by our office for your signature
and return mail or fax.
I will fax it to you now
I will mail it to you
Please fax it to me
Please mail it to me
Mailing Address:
Urban Communications, Inc.
Domain Administration Department
5320 W. 159th St. - Suite 503
Oak Forest IL 60452-3335