Create User Account - Instra Corporation - Global Domain Name Registration Services

First Name *
Last Name *
Address 1 *
Address 2
Address 3
State / Province *
Zip / Postcode *
City *
Country *
Phone *	+ . e.g. +61.397831800 (Country Code) (Phone Number)
Fax	+ . e.g. +61.397831800 (Country Code) (Fax Number)
Email *	Please enter a valid email address. Details of your account will be sent to this address after it has been created.
Confirm Email *
	I wish to receive news and updates by email
Currency *	Please select the currency you wished to be billed in. This cannot be changed later.

Extra Information
1. Are you an accredited Registrar?
Yes	No
2. How long have you been registering domain names for?
0 year	< 5 years	more than 5 years
3. What is the approximate number of names under management?
< 10 domains	< 50 domains	< 100 domains
< 200 domains	< 500 domains	more than 1000 domains
4. How many domain names do you expect to register in 3 months?
< 10 domains	< 50 domains	< 100 domains
< 200 domains	< 500 domains	more than 1000 domains
5. What domain name extensions are you most interested in?

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