Celestial Enterprises

A Division of Down Under Consultants Pty Ltd. ACN 006 657 914, ABN 74 006 657 914.

P.O. Box 235 Ringwood VIC 3134. Phone 9724 9661

Virtual Domain Name Application Form

Personal Information

Contact Name	: _________________________________

Postal Address	: __________________________________________________

__________________________________________________

__________________________________________________

Home Phone	: _______________ Business Phone : _____________________

Fax (Optional)	: _______________ Referred by (optional): __________________

Account Information

Current Account Name	: ________________@voyager.celestial.com.au

Domain name being requested	: ____________________________________________

Reason	: ____________________________________________

: ____________________________________________

Organisation requesting registration	: ____________________________________________

Full Legal name of the Organisation	: ____________________________________________

(as it appears on legal documents, not a trading name)

Organisation Postal Address	: ____________________________________________

: ____________________________________________

Australian Business Number (ABN) of the Organistion	: _____________

Australian Company Number (ACN) of the Organisation	: _____________

If no ACN, explain the nature of the organisation	: _________________________________

(explain why no ACN exists)	: _________________________________

If the domain name being sought represents a registered business name, or if no ACN exists for the organisation, please provide:

The full Registered Business Name	: _______________________________________

The Business Registration Number	: __________________

State of Business Registration	: __________________

Administrative Contact	: __________________________________________________

NIC Handle (if known)	: _________________ (If none, Celestial will arrange one)

If you have any other information to annotate to this request, add it here. Incorrect or incomplete information supplied on this form may result in a domain name application being rejected, or removed after registration.	: __________________________________________________

: __________________________________________________

Lodging the Application

After the application form has been completed and signed, attach a Cheque for the full amount (made payable to “Celestial Enterprises”) and post to: Celestial Enterprises, P.O. Box 235, Ringwood VIC 3134. Upon receipt of the application form, the applicant will be notified of any discrepancies within the application form and/or of Domain activation. For further enquires, please contact the registration department via phone on 9724 9661 or via Email at register@voyager.celestial.com.au.

2002-09-27T23:38:02