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<html>
<head>
<title>Untitled Document</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<meta name="author" content="Webagentur Niewerth - www.weban.de">
<meta name="revisit-after" content="30 days">
<meta name="language" content="deutsch, de">
<meta name="distribution" content="global">
<meta name="robots" content="all">
</head>

<body bgcolor="#FFFFFF" text="#000000">
<form name="form1" method="post" action="">
<table width="600" border="1" cellspacing="0" cellpadding="0">
  <tr> 
    <td colspan="3">Authorization</td>
  </tr>
  <tr> 
    <td width="5%">0a.</td>
    <td width="45%">(N)ew (M)odify (D)elete</td>
    <td width="50%">
        <select name="Feld_0a">
          <option value="N">New</option>
          <option value="M">Modify</option>
          <option value="D">Delete</option>
        </select>
    </td>
  </tr>
  <tr> 
    <td width="5%">0b.</td>
    <td width="45%">Auth Scheme</td>
      <td width="50%">
        <input type="text" name="Feld_0b">
      </td>
  </tr>
  <tr> 
    <td width="5%">0c. </td>
    <td width="45%">Auth Info</td>
    <td width="50%">
        <input type="text" name="Feld_0c">
      </td>
  </tr>
  <tr> 
    <td width="5%">1. </td>
    <td width="45%">Comments</td>
      <td width="50%">
        <input type="text" name="Feld_1" value="">
      </td>
  </tr>
  <tr> 
    <td width="5%">2. </td>
    <td width="45%">Complete Domain Name</td>
      <td width="50%">
        <table border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td>http://www.</td>
            <td> 
              <input type="text" name="Feld_2_1">
            </td>
            <td valign="bottom"> 
              <select name="Feld_2_2">
                  <option value=".info">info</option>
                  <option value=".biz">biz</option>
                </select>
            </td>
          </tr>
        </table>
        
      </td>
  </tr>
  <tr> 
    <td colspan="3">Organization Using Domain Name</td>
  </tr>
  <tr> 
    <td width="5%">3a. </td>
    <td width="45%">Organization Name</td>
    <td width="50%">
        <input type="text" name="Feld_3a">
      </td>
  </tr>
  <tr> 
    <td width="5%">3b. </td>
    <td width="45%">Street Address</td>
    <td width="50%">
        <input type="text" name="Feld_3b">
      </td>
  </tr>
  <tr> 
    <td width="5%">3c. </td>
    <td width="45%">City</td>
    <td width="50%">
        <input type="text" name="Feld_3c">
      </td>
  </tr>
  <tr> 
    <td width="5%">3d. </td>
    <td width="45%">State</td>
    <td width="50%">
        <input type="text" name="Feld_3d">
      </td>
  </tr>
  <tr> 
    <td width="5%">3e. </td>
    <td width="45%">Postal Code</td>
    <td width="50%">
        <input type="text" name="Feld_3e">
      </td>
  </tr>
  <tr> 
    <td width="5%">3f. </td>
    <td width="45%">Country</td>
    <td width="50%">
        <input type="text" name="Feld_3f">
      </td>
  </tr>
  <tr> 
    <td width="5%">3g. </td>
    <td width="45%">E-Mailbox</td>
    <td width="50%">
        <input type="text" name="Feld_3g">
      </td>
  </tr>
  <tr> 
    <td colspan="3">Administrative Contact</td>
  </tr>
  <tr> 
    <td width="5%">4a. </td>
    <td width="45%">Handle (if known)</td>
    <td width="50%">
        <input type="text" name="Feld_4a">
      </td>
  </tr>
  <tr> 
    <td width="5%">4b. </td>
    <td width="45%">(I)ndividual (R)ole</td>
      <td width="50%">I
        <input type="hidden" name="Feld_4b" value="I">
      </td>
  </tr>
  <tr> 
    <td width="5%">4c. </td>
    <td width="45%">Name (Last, First)</td>
    <td width="50%">
        <input type="text" name="Feld_4c">
      </td>
  </tr>
  <tr> 
    <td width="5%">4d. </td>
    <td width="45%">Organization Name</td>
    <td width="50%">
        <input type="text" name="Feld_4d">
      </td>
  </tr>
  <tr> 
    <td width="5%">4e. </td>
    <td width="45%">Street Address</td>
    <td width="50%">
        <input type="text" name="Feld_e">
      </td>
  </tr>
  <tr> 
    <td width="5%">4f. </td>
    <td width="45%">City</td>
    <td width="50%">
        <input type="text" name="Feld_4f">
      </td>
  </tr>
  <tr> 
    <td width="5%">4g. </td>
    <td width="45%">State</td>
    <td width="50%">
        <input type="text" name="Feld_4g">
      </td>
  </tr>
  <tr> 
    <td width="5%">4h. </td>
    <td width="45%">Postal Code</td>
    <td width="50%">
        <input type="text" name="Feld_4h">
      </td>
  </tr>
  <tr> 
    <td width="5%">4i. </td>
    <td width="45%">Country</td>
    <td width="50%">
        <input type="text" name="Feld_4i">
      </td>
  </tr>
  <tr> 
    <td width="5%">4j. </td>
    <td width="45%">Phone Number</td>
    <td width="50%">
        <input type="text" name="Feld_4j">
      </td>
  </tr>
  <tr> 
    <td width="5%">4k. </td>
    <td width="45%">Fax Number</td>
    <td width="50%">
        <input type="text" name="Feld_4k">
      </td>
  </tr>
  <tr> 
    <td width="5%">4l. </td>
    <td width="45%">E-Mailbox</td>
    <td width="50%">
        <input type="text" name="Feld_4l">
      </td>
  </tr>
  <tr> 
    <td colspan="3">Technical Contact</td>
  </tr>
  <tr> 
    <td width="5%">5a. </td>
    <td width="45%">Handle (if known)</td>
    <td width="50%">
        <input type="text" name="Feld_5a">
      </td>
  </tr>
  <tr> 
    <td width="5%">5b. </td>
    <td width="45%">(I)ndividual (R)ole</td>
      <td width="50%">I
        <input type="hidden" name="Feld_5b">
      </td>
  </tr>
  <tr> 
    <td width="5%">5c. </td>
    <td width="45%">Name (Last, First)</td>
    <td width="50%">
        <input type="text" name="Feld_5c">
      </td>
  </tr>
  <tr> 
    <td width="5%">5d. </td>
    <td width="45%">Organization Name</td>
    <td width="50%">
        <input type="text" name="Feld_5d">
      </td>
  </tr>
  <tr> 
    <td width="5%">5e. </td>
    <td width="45%">Street Address</td>
    <td width="50%">
        <input type="text" name="Feld_5e">
      </td>
  </tr>
  <tr> 
    <td width="5%">5f. </td>
    <td width="45%">City</td>
    <td width="50%">
        <input type="text" name="Feld_5f">
      </td>
  </tr>
  <tr> 
    <td width="5%">5g. </td>
    <td width="45%">State</td>
    <td width="50%">
        <input type="text" name="Feld_5g">
      </td>
  </tr>
  <tr> 
    <td width="5%">5h. </td>
    <td width="45%">Postal Code</td>
    <td width="50%">
        <input type="text" name="Feld_5h">
      </td>
  </tr>
  <tr> 
    <td width="5%">5i. </td>
    <td width="45%">Country</td>
    <td width="50%">
        <input type="text" name="Feld_5i">
      </td>
  </tr>
  <tr> 
    <td width="5%">5j. </td>
    <td width="45%">Phone Number</td>
    <td width="50%">
        <input type="text" name="Feld_5j">
      </td>
  </tr>
  <tr> 
    <td width="5%">5k. </td>
    <td width="45%">Fax Number</td>
    <td width="50%">
        <input type="text" name="Feld_5k">
      </td>
  </tr>
  <tr> 
      <td width="5%" height="29">5l. </td>
      <td width="45%" height="29">E-Mailbox</td>
      <td width="50%" height="29"> 
        <input type="text" name="Feld_5l">
      </td>
  </tr>
  <tr> 
    <td colspan="3">Billing Contact</td>
  </tr>
  <tr> 
    <td width="5%">6a. </td>
    <td width="45%">Handle (if known)</td>
    <td width="50%">
        <input type="text" name="Feld_6a">
      </td>
  </tr>
  <tr> 
    <td width="5%">6b. </td>
    <td width="45%">(I)ndividual (R)ole</td>
    <td width="50%">I
                <input type="hidden" name="Feld_6b">
        </td>
  </tr>
  <tr> 
    <td width="5%">6c. </td>
    <td width="45%">Name (Last, First)</td>
    <td width="50%">
        <input type="text" name="Feld_6c">
      </td>
  </tr>
  <tr> 
    <td width="5%">6d. </td>
    <td width="45%">Organization Name</td>
    <td width="50%">
        <input type="text" name="Feld_6d">
      </td>
  </tr>
  <tr> 
    <td width="5%">6e. </td>
    <td width="45%">Street Address</td>

    <td width="50%">
        <input type="text" name="Feld_6e">
      </td>
  </tr>
  <tr> 
    <td width="5%">6f. </td>
    <td width="45%">City</td>
    <td width="50%">
        <input type="text" name="Feld_6f">
      </td>
  </tr>
  <tr> 
    <td width="5%">6g. </td>
    <td width="45%">State</td>
    <td width="50%">
        <input type="text" name="Feld_6g">
      </td>
  </tr>
  <tr> 
    <td width="5%">6h. </td>
    <td width="45%">Postal Code</td>
    <td width="50%">
        <input type="text" name="Feld_6h">
      </td>
  </tr>
  <tr> 
    <td width="5%">6i. </td>
    <td width="45%">Country</td>
    <td width="50%">
        <input type="text" name="Feld_6i">
      </td>
  </tr>
  <tr> 
    <td width="5%">6j. </td>
    <td width="45%">Phone Number</td>
    <td width="50%">
        <input type="text" name="Feld_6j">
      </td>
  </tr>
  <tr> 
    <td width="5%">6k. </td>
    <td width="45%">Fax Number</td>
    <td width="50%">
        <input type="text" name="Feld_6k">
      </td>
  </tr>
  <tr> 
    <td width="5%">6l. </td>
    <td width="45%">E-Mailbox</td>
    <td width="50%">
        <input type="text" name="Feld_6l">
      </td>
  </tr>
  <tr> 
    <td colspan="3">Primary Name Server</td>
  </tr>
  <tr> 
    <td width="5%">7a. </td>
    <td width="45%">Primary Server Hostname</td>
    <td width="50%">
        <input type="text" name="Feld_7a">
      </td>
  </tr>
  <tr> 
    <td width="5%">7b. </td>
    <td width="45%">Primary Server Netaddress</td>
    <td width="50%">
        <input type="text" name="Feld_7b">
      </td>
  </tr>
  <tr> 
    <td colspan="3">Secondary Name Server(s)</td>
  </tr>
  <tr> 
    <td width="5%">8a. </td>
    <td width="45%">Secondary Server Hostname</td>
    <td width="50%">
        <input type="text" name="Feld_8a">
      </td>
  </tr>
  <tr> 
    <td width="5%">8b. </td>
    <td width="45%">Secondary Server Netaddress</td>
    <td width="50%">
        <input type="text" name="Feld_8b">
      </td>
  </tr>
  <tr> 
    <td colspan="3">Product/Service Options (For New Registrations Only)</td>
  </tr>
  <tr> 
    <td width="5%">9a. </td>
    <td width="45%">Registration Period (1-10yrs):</td>
      <td width="50%"> 
        <select name="Feld_9a">
          <option value="1">1</option>
          <option value="2">2</option>
          <option value="3">3</option>
          <option value="4">4</option>
          <option value="5">5</option>
          <option value="6">6</option>
          <option value="7">7</option>
          <option value="8">8</option>
          <option value="9">9</option>
          <option value="10">10</option>
        </select>
        Jahre </td>
  </tr>
</table>
</form>
</body>
</html>