Bekkers Domain Name Transfer For by ps94506


									                                                                                                                           Bekkers Domain Name
                                                                                                                                   Transfer Form

Note: This form is electronic. You can type the answers directly into the fields then press the print button at the bottom of this page. Please then fax to 08 9272 6625. You cannot save
the data that you have typed into this form so you will need to print a copy for your records.

Personal Information

Contact Name                                                                                              Position

Registered Business Name                                                                                  Trading Name

Registered Business Number                                                                                ABN

State of Registration                                                                                     email

Telphone Number                                                                                           Fax Number

Address                                                                                                   Suburb                                            Post Code

Domain Details

Domain Name

Current Registrant                                                                                        Domain Password

                                                                                                          Registration Key

* A once off transfer fee of $15.00 may apply to all transfers.

Important Notes
* Make sure you have discussed and understand the additional costs associated with owning and maintaining your own domain
name (such as DNS Hosting charges and Website Hosting Charges).
* Bekkers will attempt to transfer this domain name on your behalf.




       Print Form

                                         Westway Nominees Pty Ltd t/as Bekkers. ABN 50 052 073 248 - Phone: 08 9422 6777 - Fax: 08 9272 6625

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