AU DOMAINS

This form is for .com.au .net.au .asn.au .org.au ONLY
Click here to register other domains

Domain name you want:
Email Address for Lykos Websites to contact:
Preferred Password (optional):

Registrant Details: 		 
NOTE: The Registrant field must be a person, company or incorporated association, you cannot put trusts, trading names or partnerships as the registrant.
Registrant Name:  
Registrant ID Type:  
Registrant ID:   ACN/ABN ONLY
 
Eligibility Type:  
 
Trading as (optional): (check box if domain based on trading name)
Trading Name:
BRN (Business number):   State:

Claim Type:
 
Close and substantial connection:
If you are making a claim for the domain based on a "close and
substantial connection" to your business, please provide details below:
Details of connection:

Trademark claim:
If you are making a claim for the domain based on a registered
trademark, please provide details below:
Trademark Name:
Trademark Number:

First Name:  
Last Name:  
Organisation:  
Address (Line 1):  
Address (Line 2):  
Suburb:  
State:  
Postcode:  
Country:  
Email:  
Phone:  
Fax:  


Contact LYKOS, ® Jonathan Lykos 2004-2006 ABN: 60 703 100 474