NameRegistrars Registrar Transfer Request Form

Domain Name:__________________________________________
Account Name: BHWHOST
Contact Email: webmaster@bhw.com

Domain Information
Owners 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,

____________________________                            ______________________________
Signature of domain owner or admin contact                 Printed name of domain owner or admin contact

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