Domain Name Reseller Program Application - Become a Domain Name Reseller

* Company Name

* Primary Contact

* Title

* Direct Phone

+ -

* Other Phone

+ -

* Main Phone

+ -

* Email

* Website (e.g. http://www.example.com)

* Do you want to become a Reseller or a Registrar?

* Where is your business located?

* Would you prefer to work with a registrar located in your region?

Yes

No

* Do you have a preferred registrar you would like to work with?

Yes

No

If yes, which registrar?

* What TLDs are you interested in reselling? Tick all that apply

* Who is your primary target?

Individual end users

Domainers

Small - Medium businesses

Other?

* Are you currently registering any domain names?

Yes

No

* What business name or domain name do you operate from?

* What drove your decision to be a reseller and not a registrar?

* Are you thinking of selling value-added services along with registrations?

Yes

No

If yes, which ones?

Verisign respects your right to privacy, see our Privacy Statement.

Domain Name Reseller Application