Domain Name Registration

1. Domain Name

Domain Name third level (No WWW)

Second level

Top level

2. Action

New

Update

Delete

3. Registrant

First Name

Last Name

Organization

Physical Address

Postal Address

Email Address

Telephone (H)

Telephone (W)

Mobile

6. Nameservers

Primary FQDM

Primary IP Address

Secondary FQDM

Secondary IP Address

Tertiary FQDM

Tertiary IP Address

7. Fees, Terms & Conditions

1. Domain Name Registrations are subject to terms and conditions as published from time to time at: http://leo.co.ls.

2. An annual fee of M230.00 (Two Hundred and Thirty Maloti) is payable yearly, in advance.

3. This covers the cost of updates that may be made to registration details. The complete removal of a domain is free of charge.

4. Registration fees may be paid at our front desk, or by transfer to: LEO (PTY) Ltd, Nedbank, Pioneer Mall, Branch Code: 390861, Account No. 091000001703. Alternatively, by arrangement which may be made with: accounts@leo.co.ls.

8. Signature

Name in full

Designation

Date

9. ISPs & Registrars

If you are registering this name on behalf of a third party, please confirm.

I confirm I am registering on behalf of a third party