General Domain Request Form

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Your Domain & Extension For multiple domains, please separate by commas
Name:
Company name:
Address:
Address line 2:
City:
Province/state:
Postcode:
Country:
Telephone number:
Fax number:
Email:
Credit card number:
Credit card type:	Please Select
Credit card expiry date (MM/YY):	Please Select
Name On Credit Card
Credit Card Security ID:	Illegible

In an effort to reduce fraud we asking for the Security ID for the cards listed below. If your card does not have a Security ID on it you may leave the field blank. If the Security ID on your card is unreadable, you should check the "Illegible" box.
See the links below for an image of the location of the Security ID on your card.

American Express : Security ID is printed on front of card above the credit card number.
Euro Card : Security ID is printed on back of card above the credit card number.
Master Card : Security ID is printed on back of card above the credit card number.
Optima : Security ID is printed on front of card above the credit card number.
Visa : Security ID is printed on back of card above the credit card number.

	Your Credit Card Billing Address
CCard Billing :Street Address:
Credit Card Billing :City
Credit Card Billing :State
Credit Card Billing :Country
Credit Card Billing Zip Code
Addition Information (if any)

	DNS Server Information
Primary DNS Server	No IP. example: ns.rwgusa.net
Secondary DNS Server	No IP. example: ns1.rwgusa.net
Forwarding URL Address

If you don't specify Primary and Secondary DNS Server, our Primary and Secondary DNS Server and MX Record will be set:

Primary DNS Server: ns.rwgusa.net
Secondary DNS Server: ns1.rwgusa.net

International Domain Names will be pointed via different countries' DNS servers.

101 Internet Service
Rightway Gate Inc.
910 W. San Marcos Blvd #210
San Marcos, CA 92078

Phone: Toll Free US
1-888-398-4703
Phone: International
++1-760-736-3700
Fax: 1-760-736-3701

Copyright © 2005
All Rights Reserved.



	Copyright ©2005 By Rightway Gate Inc. The Smart Business Online Contact,