New Domain Name Registration Form
To register a new Domain Name through Nucleus please fill out the form below. Once we have received your request we will register the requested Domain Name on your behalf.
* = Required field
First Name: *
Last Name: *
If you are a current Nucleus customer, please enter your Account Number which can be
found on your invoice from Nucleus under the heading of
'Your Customer ID Number'
Account Number:
Organizational Information (Optional)
Organization:
Job Title:
Industry:
Please Select
Agriculture & Foresty/Wildlife
Business & Information
Construction/Utilities/Contracting
Education
Finance & Insurance
Food & Hospitality
Gaming
Health Services
Motor Vehicles
Natural Resources/Environmental
Other
Personal Services
Real Estate & Housing
Safety/Security & Legal
Transportation
Department:
Email: *
Phone Number: *
-
-
Street Address: *
City: *
Province/State: *
Country: *
Please Select
Canada
United States
Postal/Zip Code: *
Domain Name: *
Term: *
Please Select
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
Please type the above number: