Norton Authenticated Request Form

A Norton Authenticated Web page has been verified by Symantec as belonging to the company represented. Please provide the following information for the Web site that you want to be evaluated as a possible Norton Authenticated Web site.

(If you are not the Web site owner, please use the form here.)

This submission form is SSL Secured.

* Required fields are marked with an asterisk.


Your first name:

*


Your last name:

*


Your title:

*


Company name:

*


Address 1:

*


Address 2:


City:

*


State/Province:

*


ZIP/Postal Code:

*


Country:

*


Telephone number:

*


Fax number:


Your email address:

*


Name of the Web site (example: Keypoint Credit Union):

*


The domain name or URL of the Web site (example: http://www.keypointcu.com/):

*
enter more / enter fewer


Associated country-specific domain names or URLs (for companies that have associated domains in several countries):


enter more / enter fewer


Associated partner domain names or URLs (for companies that may have business with partners that are reflected on their site):


enter more / enter fewer


Please choose the statement below that applies to this Web site:

This Web site is a new candidate for authentication.      This Web site is already a Norton Authenticated site, but is not identified as such in my Web browser.      *


Enter any comments into the box below.


Please type the security characters into the answer field below. This step is necessary to prevent abuse.

Security characters

   

Answer

 *


Please do not Submit files that contain personal data as part of your submission.
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