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DNS Request Form

Completing this DNS Request Form 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.

Fields marked with an asterisk (*) are required.
DNS RequestForm
1. Is this a new DNS build or a modification to an existing DNS build?*   New     Modification
2. Select Service*  

or

3. Bill To Number (BTN):*   ( ) -
     
4. Company Name:  
5. Customer Contact Name:  
6. Customer Contact Phone Number:   ( ) -
7. Customer Contact Email Address:  
8. Domain Name:  
9. Service address, city, state and zip    
Address
  
City
  
*State
  
Zip
  
     
10. Do you want SBCIS to be your Primary and Secondary DNS at an additional one-time charge of $100 per domain name?   Yes     No
     
11. If you answered no to question 10, please provide your PRIMARY and SECONDARY Hostname and IP address information. Otherwise proceed to question 12.
    
Primary Server Hostname  
Primary Server IP Address  
Secondary Server Hostname  
Secondary Server IP Address  
     
12. Do you have a mail server software program?   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. If applicable, provide the Hostname of your www server:  
14. If applicable, provide the IP address of your www server:  
15. If applicable, provide the Hostname of your ftp server:  
16. If applicable, provide the IP address of your ftp server:  
17. If applicable, provide the Hostname of your proxy server:  
18. If applicable, provide the IP address of your proxy server:  
     
19. For Enhanced DSL Customers: Would you like to continue to use your pacbell.net and News access?   Yes     No
a) If yes, what IP Address would you like to assign to your pacbell.net and News access? This IP has to be different from your server IP(s).
  
20. Did you talk to a DNS coordinator? Please provide their name:  
 
21. Please provide any additional comments or relevant information:
 

There is a $100 charge for establishing Primary DNS service per additional domain name. 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 business/enhanced and dedicated customers.

Send form by clicking "Submit" below

For DSL DNS Needs, call:
DSL Provisioning 800-833-2120 Options 1, 2, 1

For Dedicated Access DNS Needs, call:
Dedicated Enhanced Service Center (DESC)1-866-937-3664, Options 3,5

For SBCIS Sales, call:
1-888-724-7253

For Web Hosting services, call:
Web Hosting Sales: 888-WEB-HOST (1-888-932-4678)
    

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