Leo (PTY) LTD
             Registrar of names in the CO.LS and ORG.LS domains


                APPLICATION TO ESTABLISH A SUB-DOMAIN

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     |                                                                 |
     |        ** TERMS AND CONDITIONS OF REGISTRATION **               |
     |Domain registrations are subject to the terms and                |
     |conditions as published at http://co.ls from time to time.       |
     |                                                                 |
     |                ** COSTS OF REGISTRATION **                      |
     |                                                                 |
     |DOMESTIC REGISTRATIONS:                                          |
     |There is an annual fee of M228 (Two Hundred Twenty Eight Maloti) |
     |payable yearly in advance. This covers the cost of any updates   |
     |that maybe made to the domain.                                   |
     |The complete removal of a domain is free.                        |
     |Please E-Mail completed form once the domain is ready to...      |
     |             accounts@leo.co.ls                                  |
     |                                                                 |
     |INTERNATIONAL REGISTRATIONS:                                     |
     |Please contact ... admin@co.ls                                   |
     |                                                                 |
     |                                                                 |
     |Please send any other queries to: accounts@leo.co.ls             |
     |                                                                 |
     |                                                                 |
     |Postal Address: Leo (PTY) LTD   Street Address: Leo (PTY) LTD    |
     |                P O Box 11702                Taoana Centre       |
     |                Maseru 100                   Orpen Rd            |
     |                Lesotho                      Maseru              |
     |                                                                 |
     |Fax.      +266 22317816                                          |
     |Phone.    +266 22322772                                          |
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 1. DOMAIN NAME and ACTION

    Domain names assigned by LEO (PTY) LTD consist of three levels, 
    eg:   thisnetwork.co.ls.	(do not include www.)
    

	    :			                    .        .ls 


 2. ACTION
  							
    [N]ew, [U]pdate, or [D]elete (N/U/D)            :
    Cost of this application   -  M228.00 incl VAT			


 3. DOMAIN OWNER

    a. Select [I]ndividual, or [O]rganisation (I/O) :
    b. Name (first, last)                           :
    c. Organisation                                 :
                                                    :    

    d. Street address                               :
                                                    :
    e. Post address                                 :
                                                    :
    f. email address                                :
    g: telephone                                    :


 4. ADMINISTRATIVE / BILLING CONTACT

    a. Name (first, last)                           :
    b. Post address                                 :
                                                    :
    c. email address                                :
    d: telephone                                    :


 5. TECHNICAL CONTACT

    a. Name (first, last)                           :
    b. Organisation                                 :
    c. email address                                :
    d: telephone                                    :
    e: cell phone                                   :


 6. NAMESERVERS FOR THIS DOMAIN

    Domain administrators should provide at least two independent 
    nameserver hosts for the requested domain.  
    Give the "FQDN' (Fully Qualified Domain Name) 
    - the machines Full name.

        ***  IF YOU DO NOT KNOW SOMETHING - LEAVE IT BLANK ***

    a. Primary server FQDN                          :
    b. Primary server IP address                    :

    c. Secondary server FQDN                        :
    d. Secondary server IP address                  :

    
 7. AWARENES

    If this domain is being registered in the name of an ISP, 
    Is the client / owner aware of this fact?

    [Y]es, or [N]o  (Y/N)                           :


 8.Signed By



Owner Signature...............			ISP Signature..............

Date:						Date: