Domain request | Proximus

Domain name request form

All fields are mandatory except those where "optional" is mentioned.

Information about your domain name

Request concerns (optional) {{errorMessages.status.required}} {{errorMessages.status.pattern}} {{errorMessages.status.pattern}} {{errorMessages.status.pattern}} {{errorMessages.status}} {{errorMessages.status.pattern}}

New domain name / Transfer of domain name (optional) {{errorMessages.domainName.required}} {{errorMessages.domainName.pattern}} {{errorMessages.domainName.pattern}} {{errorMessages.domainName.pattern}} {{errorMessages.domainName}} {{errorMessages.domainName.pattern}}

Transfercode (optional) {{errorMessages.importAuthorisationCode.required}} {{errorMessages.importAuthorisationCode.pattern}} {{errorMessages.importAuthorisationCode.pattern}} {{errorMessages.importAuthorisationCode.pattern}} {{errorMessages.importAuthorisationCode}} {{errorMessages.importAuthorisationCode.pattern}}

Your information

Customer number (found on your Proximus bill) (optional) {{errorMessages.custid.required}} {{errorMessages.custid.pattern}} {{errorMessages.custid.pattern}} {{errorMessages.custid.pattern}} {{errorMessages.custid}} {{errorMessages.custid.pattern}}

Landline number (linked to your Internet subscription) (optional) {{errorMessages.landline.required}} {{errorMessages.landline.pattern}} {{errorMessages.landline.pattern}} {{errorMessages.landline.pattern}} {{errorMessages.landline}} {{errorMessages.landline.pattern}}

Customer data

Companyname (optional) {{errorMessages.company.required}} {{errorMessages.company.pattern}} {{errorMessages.company.pattern}} {{errorMessages.company.pattern}} {{errorMessages.company}} {{errorMessages.company.pattern}}

First name {{errorMessages.firstname.required}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname}} {{errorMessages.firstname.pattern}}

Last name {{errorMessages.name.required}} {{errorMessages.name.pattern}} {{errorMessages.name.pattern}} {{errorMessages.name.pattern}} {{errorMessages.name}} {{errorMessages.name.pattern}}

Address (optional) {{errorMessages.address.required}} {{errorMessages.address.pattern}} {{errorMessages.address.pattern}} {{errorMessages.address.pattern}} {{errorMessages.address}} {{errorMessages.address.pattern}}

Postal code (optional) {{errorMessages.zipcode.required}} {{errorMessages.zipcode.pattern}} {{errorMessages.zipcode.pattern}} {{errorMessages.zipcode.pattern}} {{errorMessages.zipcode}} {{errorMessages.zipcode.pattern}}

City (optional) {{errorMessages.city.required}} {{errorMessages.city.pattern}} {{errorMessages.city.pattern}} {{errorMessages.city.pattern}} {{errorMessages.city}} {{errorMessages.city.pattern}}

VAT number (optional) {{errorMessages.vat.required}} {{errorMessages.vat.pattern}} {{errorMessages.vat.pattern}} {{errorMessages.vat.pattern}} {{errorMessages.vat}} {{errorMessages.vat.pattern}}

Mobile phone number ex: 0475000000 {{errorMessages.mobile.required}} {{errorMessages.mobile.pattern}} {{errorMessages.mobile.pattern}} {{errorMessages.mobile.pattern}} {{errorMessages.mobile}} {{errorMessages.mobile.pattern}}

E-mail {{errorMessages.email.required}} {{errorMessages.email.pattern}} {{errorMessages.email.pattern}} {{errorMessages.email.pattern}} {{errorMessages.email}} {{errorMessages.email.pattern}}

Configuration

Below you can choose the configuration of your domain name. You can change this setting later. In case of doubt, choose the standard configuration.

Select the type of configuration {{errorMessages.configuration.required}} {{errorMessages.configuration.pattern}}

Mailserver name name.mailserver.be {{errorMessages.mailservername.required}} {{errorMessages.mailservername.pattern}} {{errorMessages.mailservername.pattern}} {{errorMessages.mailservername.pattern}} {{errorMessages.mailservername}} {{errorMessages.mailservername.pattern}}

IP of the mail server {{errorMessages.ipmailserver.required}} {{errorMessages.ipmailserver.pattern}} {{errorMessages.ipmailserver.pattern}} {{errorMessages.ipmailserver.pattern}} {{errorMessages.ipmailserver}} {{errorMessages.ipmailserver.pattern}}

Name of your web server webserver.mydomain.ltd {{errorMessages.webservername.required}} {{errorMessages.webservername.pattern}} {{errorMessages.webservername.pattern}} {{errorMessages.webservername.pattern}} {{errorMessages.webservername}} {{errorMessages.webservername.pattern}}

IP of your webserver {{errorMessages.ipwebserver.required}} {{errorMessages.ipwebserver.pattern}} {{errorMessages.ipwebserver.pattern}} {{errorMessages.ipwebserver.pattern}} {{errorMessages.ipwebserver}} {{errorMessages.ipwebserver.pattern}}

Connexion beyween my domainname and my mailboxes {{errorMessages.connexion.required}} {{errorMessages.connexion.pattern}}

For this, please enter the existing domain name (DNS) of the organization. {{errorMessages.dnscloud.required}} {{errorMessages.dnscloud.pattern}} {{errorMessages.dnscloud.pattern}} {{errorMessages.dnscloud.pattern}} {{errorMessages.dnscloud}} {{errorMessages.dnscloud.pattern}}

For this, please enter the existing domain name (DNS) of the organization.microsoft {{errorMessages.dnsmicrosoft.required}} {{errorMessages.dnsmicrosoft.pattern}} {{errorMessages.dnsmicrosoft.pattern}} {{errorMessages.dnsmicrosoft.pattern}} {{errorMessages.dnsmicrosoft}} {{errorMessages.dnsmicrosoft.pattern}}

For this, please enter your e-mail login {{errorMessages.dnsskynet.required}} {{errorMessages.dnsskynet.pattern}} {{errorMessages.dnsskynet.pattern}} {{errorMessages.dnsskynet.pattern}} {{errorMessages.dnsskynet}} {{errorMessages.dnsskynet.pattern}}

Hosting rates

Also interested in our hosting formulas? (optional) {{errorMessages.hosting.required}} {{errorMessages.hosting.pattern}}

Hosting (Windows) (optional) {{errorMessages.hostingwindows.required}} {{errorMessages.hostingwindows.pattern}}

Hosting (Linux) (optional) {{errorMessages.hostinglinux.required}} {{errorMessages.hostinglinux.pattern}}

Discover our hosting rates for Windows and Linux here

I hereby declare that I have read the general terms and conditions¹ and the specific terms and conditions²

I agree to the general and specific terms and conditions. {{errorMessages.agreement.required}} {{errorMessages.agreement.pattern}}

The following specific terms and conditions apply in addition to the general terms and conditions of Proximus.

I would like to be kept informed about products, services, contests and promotions of Proximus. To this end, Proximus may store my personal data in its files and may contact me, including by phone and via electronic channels such as e-mail, SMS and social media. I’m aware that my data is processed in accordance with Proximus' privacy policy which informs me how to manage my privacy settings.

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Domain name request form

Information about your domain name

Your information

Customer data

Configuration

Hosting rates

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Information about your domain name

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Customer data

Configuration

Hosting rates

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