Service & Support - Domain Name Worksheet

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DNS Request

Completing this Domain Name Worksheet is a necessary step developed to insure that the DNS Management Administrator at SBC Internet Services obtains up-front information about your network. Please be as thorough as possible—it is required to include the alpha/numeric name of your mail server and to include the alpha/numeric names of your web, ftp & proxy servers if applicable.

Requests to support for additional Domain Names require a separate form for each. Upon receipt of the completed template the Dedicated Customer Care department will process your request.

Please fill out the fields marked with an asterisk ( * ) so that we can contact you with any questions.

Domain Name Worksheet
*Basic, Enhanced and Business DSL DNS requests, please refer to http://dialup.pacbell.net/dn_worksheet.html or call 1-800-833-2120, option 1,2 for California or Nevada customers. For all other states, please refer to http://dialup.swbell.net/customer/dn_worksheet.html or call1-877-SBC-DSL5.

* 1. Is this a new DNS build, a modification to an existing DNS build, or a request for reverse delegation?	New Modification Reverse Delegation
* 2. Select Service
* 3. Company Name:
* 4. Customer Contact Name:
* 5. Customer Contact Phone Number:	( ) -
* 6. Customer Contact Email Address:
* 7. Domain Name:
a) additional domain name:
b) additional domain name:
* 8. Service address, city, state and zip
Address
City
State
Zip
9. Do you want SBCIS to be your Primary and Secondary DNS at an additional one-time charge of $100 per domain name?	Yes No
10. If you answered no to question 9, or if you are requesting reverse delegation on your IP block, please provide your PRIMARY and SECONDARY Hostname and IP address information. Otherwise proceed to question 11.
Primary Server Hostname:
Primary Server IP Address:
Secondary Server Hostname:
Secondary Server IP Address:
11. For Reverse Delegation requests: If you are requesting a pointer record, please provide the following information:
Domain Name:
Primary Server IP Address/CIDR:
12. Do you have a mail server?	Yes No
a) If you do, then provide the Hostname you want assigned:
b) If you do, then provide the IP address you want assigned:
13. Do you have a www server?	Yes No
a) If you do, then provide the Hostname you want assigned:
b) If you do, then provide the IP address you want assigned:
14. Do you have an ftp server?	Yes No
a) If you do, then provide the Hostname you want assigned:
b) If you do, then provide the IP address you want assigned:
15. Do you have a proxy server?	Yes No
a) If you do, then provide the Hostname you want assigned:
b) If you do, then provide the IP address you want assigned:
16. Did you talk to a DNS coordinator? Please provide their name:
17. Please provide any additional comments or relevant information:
There is a $100 charge for establishing Primary DNS service per additional domain name after the initial 3 domain names. There is a $50 charge per domain name for change requests made on a customer's existing domain name after the customer's initial DNS request. Secondary DNS is offered currently at no charge to dedicated customers. Reverse Delegation is offered currently at no charge to dedicated customers. Send form by clicking "Submit" below For Dedicated Access DNS Needs, call: Dedicated Enhanced Service Center (DESC) 1-866-937-3664 option 3, then 5 For SBCIS Sales/Web Hosting services, call: 1-888-792-0999. For Shared Webhosting call: 1-888-WEB-HOST, option 1 For Dedicated Webhosting call: 1-877-722-4378.

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