Domain Name: ________________________________________________________________

Account Name: ________________________________________________________________

Contact Email: ________________________________________________________________

Domain Information

Owner’s Name: ________________________________________________________________

Organization name: ______________________________________________________________

Street Address: _________________________________________________________________

City: ______________________________ State: ______________________________________

Zip/Postal code: ______________________ Country: ___________________________________

Current Registrar: ________________________________________________________________

Transfer Authorization

I hereby authorize the transfer of the above domain name from the current registrar to NameRegistrars (CORE-95). I certify that I am authorized to make changes to this domain name. The information included on this form is accurate to the best of my knowledge. 

Please include a copy of the above signed party’s photo ID below. The registrar transfer cannot be processed without this authentication.