Customer DNS Services Form

EMBARQ IP Services Customer DNS Services Form

Use this form to add, modify, or delete DNS records for your domain.

Note: For a DNS delegation, please use the DNS delegation form

Please fill out all fields completely. Missing or inaccurate information in your DNS request may cause delays. Please allow a minimum of 2 business days for your request to be processed.

Contact Information
Company Name
Contact Name
Contact Phone #		--
Contact Hours
Contact Email
Your Circuit
Full Circuit ID
Network (WAN) Address
City, State (ex: Orlando, FL)
DNS Information
Domain Name
Type of Request		New  Modify  Delete

IP Numbers and Hostnames to be changed or added (Please specify all of your requests in the following format):

Add / Modify / Delete       Type (A, MX, PTR, CNAME)      IP Address      Hostname

Additional Relevant Information (Name servers, MX records, etc.)

Comments / Questions

NOTE: If you know of specific upcoming DNS changes that will significantly affect service to your domain, we strongly suggest that you plan ahead and notify us as far in advance as possible. We cannot guarantee you immediate service due to the volume of requests received.

NOTE: For any requests that cannot be handled via this form, please call 1-800-603-8044, options 1,1 and open a ticket.