Domain Name Registration - Transfer

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					                                            Domain Name Registration / Transfer
                             (any domain name ending with .nz, .biz, .info, .net, .org and .com) Doc v1.05
                                           professional development limited
                                                www.professionaldevelopment.co.nz
                                      Phone +64 (6) 3577 633 - Fax +64 (6) 3577 632 - Email domains@prodev.co.nz

Registrant Name:___________________________________________________________________________________
(Normally this is a company name, please include Ltd if this is a limited liability company)

Admin Contact:____________________________________________________________________________________
(This is also the contact person for the account. This can either be a persons name, or a job title, e.g. Chief Executive of Your Company Ltd)

Email Address:_____________________________________________________________________________________
(This is the Registrant email address that you would like to be the first contact point for any queries, plus in some cases will be a billing email address)

Postal Address:____________________________________________________________________________________
(Full postal address including City and Postal Code if available)
__________________________________________________________________________________________________

Phone:______________________________________ Other Phone/Fax:______________________________________

WHAT DOMAIN NAME(S) WOULD YOU LIKE TO REGISTER / TRANSFER? (please print clearly)
NOTE: If you are transferring a domain we will need the UDAI key. If you do not know it, you will need to contact your current Domain Name Registrar.

DOMAIN NAME 1: __________________________________________________________________________________

Is this a first time       Registration & Date:_________________or a                           Transfer & UDAI: __________________________
(please tick one)                                                                               (if applicable)

   1 Year Registration $45.00 incl. GST 2 Year Registration $90.00 incl. GST Monthly $4.00 incl. GST (minimum 12 mths)
__________________________________________________________________________________________________

DOMAIN NAME 2: __________________________________________________________________________________

Is this a first time       Registration & Date:_________________or a                           Transfer & UDAI: __________________________
(please tick one)                                                                               (if applicable)

   1 Year Registration $45.00 incl. GST 2 Year Registration $90.00 incl. GST Monthly $4.00 incl. GST (minimum 12 mths)
__________________________________________________________________________________________________

DOMAIN NAME 3: __________________________________________________________________________________

Is this a first time       Registration & Date:_________________or a                           Transfer & UDAI: __________________________
(please tick one)                                                                               (if applicable)

   1 Year Registration $45.00 incl. GST 2 Year Registration $90.00 incl. GST Monthly $4.00 incl. GST (minimum 12 mths)
__________________________________________________________________________________________________
Preferred payment by Direct Credit to ‘Professional Development Ltd’ with the following bank details;
Bank:     Westpac
Account: 03 1522 0074001 00
Please use your company name and/or keyword ‘domain’ in payment details.

TERMS AND CONDITIONS
I confirm that I, or my client, is the applicant for the domain name that is the subject of this request, and agree to indemnify Professional Development Ltd
for any cost, losses or liabilities incurred, in the reasonable performance of their duties in processing this request, or in the dealing with claims arising from
the allocation or use of the domain name(s) herein.

I now require that the information on this domain name registration form be processed by Professional Development Ltd to register a new name on my
behalf. I shall indemnify Professional Development Ltd prior to purchase by Professional Development Ltd of all costs incurred by them and/or any 3rd
Party to complete the purchase as outlined within this document.

I / We acknowledge I / We have read and accept the attached terms and conditions, in conjunction with the disclaimer and privacy policy held at the
official Professional Development Limited website at http://www.professionaldevelopment.co.nz/legal/terms.php

Signature of Registrant Applicant:__________________________________________________ Date:_____________


          Please fax to (06) 3577 632 or post to Professional Development Ltd, PO Box 10047, Palmerston North 4441