If you were the registrant for a domain name that you feel was transferred away from our registrar without your approval, please fill out the information below. In order for us to assist you in your claim, all of the following information must be provided. Please send the following form along with the required documents to [email protected] or fax to 480-287-8002. Once we verify the information below we will contact the current registrar to attempt to resolve the problem.

Domain Information:

Domain Name:

___________________________________________________________

Registrant’s First Name at the time of the Transfer:

__________________________________

Registrant’s Last Name at the time of the Transfer:

__________________________________

Company Name at the time of the Transfer:

_____________________________________

I have attached a copy of the registrant’s government issued photo identification to this form. (Please lighten the photo ID before faxing). If the person signing the request is not the registrant, please submit an ID for both the registrant and the requester.

Attach Photo ID Here

* A photo ID is a copy of a State Issued Driver’s License or a Passport with a photo.
If a company is listed under Registrant, I have attached a government issued photo identification of the person signing below and have attached one of the following documents for company identification (company name must match exactly).

• A copy of business license
• Tax certificate (number alone is not acceptable)
• “Doing Business As” documentation
• Fictitious Name Documentation
• IRS 501(C)3 “Determination Letter”
• State issued certificate of tax exemption showing charitable status

Attach Company Documents Here

* Attach larger documents or multiple page documents to the end of this form.

Daytime Phone Number (in case we have questions):

_________________________________________________________________

Valid Email Address:

_________________________________________________________________

A valid email address must be provided for Domain Services to respond. The email address given must not be associated with the domain(s) the dispute is requested on.

I am requesting that Domain Services verify registrant information and contact the current Registrar to attempt to transfer the domain name back to my account. I certify and affirm that I am the registrant listed above, or, if not the registrant, I am the authorized requester of the registrant. I agree that neither Registrar nor any of its affiliates shall be liable to me or any other party in any amount for any actions taken pursuant to this request. I hereby waive and release any and all claims related to this request asserted against Registrar or any of its affiliates. Additionally, I agree to defend, indemnify, and hold harmless Registrar and its affiliates for any loss, liability, damages, costs or expenses (including reasonable attorneys’ fees) resulting from any third-party claim, action or demand related to this request, this authorization, or any actions taken by Registrar in connection therewith.

If the government issued photo or company identification you have supplied is found to have been altered or is not a valid form of ID, you understand and agree that we may, at our discretion, share this information with other registrars or law enforcement.

Signed Name:

_____________________________________________________

Date:

__________________________________

(Registrant or Authorized Requestor’s Signature)

Printed Name:

____________________________________________________________