Revised: January 2006

This form is for use only by Texas Higher Education Network (THEnet) subscribers and the UT System Network (UTSN) members.

The UT System Office of Telecommunication Services (OTS) provides secondary name service to THEnet and UTSN members upon request. This form must be completed in order to request secondary name service for your domain(s) from OTS.

1. Domain Name Information

Provide the names of the domains for which secondary name service is requested. List them one per line in the text area below, with no extra punctuation such as commas separating the domain names. This list can include both "forward" domains such as utsystem.edu and "reverse" domains such as 1.76.206.in-addr.arpa.

All the domains you list in the text area must have the same primary name server. If this is not the case, then submit multiple copies of this form, one for each set of domains which have the same primary name server. Use as much space in the text box below as you need.

Domain Names	Provide the names of the domains for which secondary name service is requested.

2. Primary Name Server

Provide the fully qualified domain name (FQDN) and IP address of the primary name server for these domains. The primary name server listed here must be operational, reachable from the Internet, and serving all the domains you list at the time you submit this form.

Primary Name Server FQDN
Primary Name Server IP Address

3. Technical Contact Information

The technical contact is responsible for resolving technical problems associated with the domain and the primary name server.

Last Name
First Name
Name of Organization
Email Address
Telephone Number

4. Requester Information

The requester is the person filling out this form. If you are the Technical Contact listed above, indicate this with the checkbox and leave the rest of this section blank.

Check this box if the requester is the same as the Technical Contact	(If this button is checked, the rest of this section will be ignored.)

Last Name
First Name
Email Address
Telephone Number

5. Submit Form

Click Submit Request to send your request to the OTS registrar.

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