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Starfield Technologies, Inc. Confidential and Proprietary 2008 Version 2,0 July 18, 2008
REQUEST FOR DIGITAL CERTIFICATE ACTION
In order for the Starfield Registration Authority Administrator to take action for the digital certificate on your behalf,
registrant information must be verified. Please scan and email this completed form along with your identification
documents to: ra@starfieldtech.com with “Accept” or “Revoke” in the email subject line. You may also fax this form
and the required identity documentation to: (480)624-2548. Please allow up to 2 business days for an initial response.
**Please Note** The Common Name refers to the exact URL of the certificate request.
Common Name of Certificate: _______________________________________________________________
**Registrant refers to the owner of the domain as shown in a public WHOIS database**
Registrant Information:
Company or DBA Name: ___________________________________________________________________
First Name: _____________________________________________________________(Leave blank if not shown on WHOIS)
Last Name: _____________________________________________________________(Leave blank if not shown on WHOIS)
Identification Documentation Required:
Please provide a copy of a current government issued photo identification (driver’s license, state/federal/military ID or
passport). NOTE: FAXed photo IDs may be requested to be resent as scanned and emailed images if the FAXed copy is not
clear enough for use as an identification tool.
If an individual is listed as Registrant: They must sign this form and the photo ID must be theirs.
If a company name is listed as Registrant: The agent of the company must sign this form and the photo ID must be the signer’s.
Also one of the following documents for company identification must be provided. (Company name must match exactly.)
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