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Date:_________________________________________ Lessee Officer Name:____________________________ Lessee Officer Signature:_________________________. Date:_________________________________________ Lessor Officer Name:____________________________
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Date:_________________________________________ Lessee Officer Name:____________________________ Lessee Officer Signature:_________________________ Date:_________________________________________ Lessor Officer Name:____________________________ Lessor Officer Signature:__________________________ Nameservers Change? Nameserver 1 Nameserver 2 Nameserver 3 Nameserver 4 XYZ.com Registrar Settings Change Authorization DNS Record Changes Change? A (Host) CNAME (Alias) MX (Mail Exchanger) TXT (Text) SRV (Service) AAAA (Ipv6 Host) Additional Changes This authorization, along with screenshot or Register confirmation of requested changes shall be faxed or emailed to Lessee within 48 hours of change request