Generic Domain Email Services

Generic Domain Email Services Request Form

1. Organisation / Company Details

Organisation Name:

Business Registration Number (from IPA Certificate):

Current Physical Address:

Postal Address (if different):

2. Contact Person Details

Full Name:

Designation / Role:

Mobile Number:

Alternative Contact Email:

3. Domain Information

Proposed Domain Name (e.g. mybusiness.com):

4. Email Accounts Requested

List of Personal Emails to Create (one per line)

List of Email Aliases / Group Emails (one per line):

5. Payment Information

Payment Method: { Account Name: COMTECH PNG , Account Number: 7018667027 , Account Branch: BSP HAUS (950)}

Bank Transfer Cash Deposit Mobile Money

Reference / Transaction ID:

Upload Proof of Payment (attach separately)

Upload Current IPA Certificate (attach separately)

6. Additional Notes or Instructions

Additional Notes:

7. Acknowledgment

I confirm that the information provided above is correct and I agree to the service fees

Full Name:

Date: