Change of Admin-c (gTLD domains) request form

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Change of Admin-c (gTLD domains) request form
Important notice: this form is no more requested to change admin-c

City, date

                          NETREGISTER.BIZ
                          Phoenix Informatica srl
                          Customer Service
                          P.O. Box 1897
                          Gavardo, BS 25085 IT

Object: Admin-c Changes.

Il sottoscritto (Here, admin-c)...............................
titolare del dominio (Admin-c of domain)......................
chiede il cambio di Admin-c secondo i seguenti parametri
(requests the Admin-c change with the following parameters):

Administrative Contact
 1.  Nome (First Name).........: _____________________________
 2.  Cognome (Last Name).......: _____________________________
 3.  Name (Last, First)........: _____________________________
 4.  Societa' (Organization)...: _____________________________
 5.  Indirizzo (Street Address): _____________________________
 6.  Comune (City).............: _____________________________
 7.  Provincia (State).........: _____________________________
 8.  CAP (Postal Code).........: _____________________________
 9.  Nazione (Country).........: _____________________________
10.  Telefono (Phone Number)...: _____________________________
11.  Fax (Fax Number)..........: _____________________________
12.  E-Mail....................: _____________________________

Firma e timbro del Cedente
Signature old Admin-c

Firma e timbro del Cessionario
Signature new Admin-c

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