NicProxy Domain Registrar

Please fill out this enrollment form below completly. Accurate information is necessary for your enrollment appraisal. We will contact you with more information on how to become reseller.

Confidential and Privacy: The information you provide to the NicProxy allows the NicProxy to appraise of your enrollment information and to contact you of reseller program. All information is confidential and will not be shared with any third party.

Company Information
Enrollment Type	Company Individual
Company Name	*
Address	*
City	*
Zip Code	*
Country	*
Phone number	*
Fax number	*
Website URL	*
Administrative Contact
First Name and Last Name	*
E-mail Address	*
Reseller/RSP Information
Company size	Select 1 - 10 person 10 - 50 person 50 - 100 person 100 - 200 person 200 +
What is the core business of your company?	Select Internet Service Provider (Domain and Hosting) Software and IT Web Agency (Web Design) Advertising and Marketing Media Service Education Other
How many domain names do you currently manage?	Select 0 - 20 20 - 80 80 - 200 200 - 500 500 +
How many domain names do you plan to register in a month?	Select 0 - 10 10 - 50 50 - 100 100 +
What domain name extensions you currently offer?	com, net, org, info, biz mobi, ws, tv, cc, co
Technical Information
Do you have your own DNS Servers?	Yes No
Do you think to use API integration?	Yes No
Are you use third party platform such as AWBS, WHMCS?	Yes No
Operating System on your servers	Windows Server Linux
Other Information
How did you hear about us?	Recommendation Advertisement Search Engines Press Other
Your Message
Security Code
Security Code	*

* All marked fields are required.