Domain Name Registration Form |
>IMPORTANT! Please Complete The
Following Required Fields Marked In Red.
|
| Organization
Information |
| Transaction
Type: |
New Domain Name Registration
Re-Registration
Of Existing Domain Name |
| Name: |
If It's Not A Company, Please Enter The First Name And The Last Name
Of The Individual. |
|
|
| Description
Of Registrant: |
>Brief Description (< 250 Characters Of The Domain Name ) |
Do
you want to upgrade your
sub-domain name (i.e.
yourcompany.on.ca) to a top
level domain name (i.e.
yourcompany.ca)? If
applicable to your existing domain name? |
|
| .CA Domain: |
|
>**To
Register Additional Domain Names, Please Fill The Following Fields. If Not, Please
Continue To The Next Section Below. For Great Savings On Registering 10 Or More Domain
Names, Use The "Bulk Registration Form"
|
| .CA Domain: |
|
| .CA Domain: |
|
| .CA Domain: |
|
| .CA Domain: |
|
| .CA Domain: |
|
| .CA Domain: |
|
| .CA Domain: |
|
| .CA Domain:
|
|
| .CA Domain:
|
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| Is The
Submitted Domain Name A Trademark?: |
Yes
No |
| Do You Want To
Be A CIRA Member?: |
|
| Reference
Information: |
Provided By CIRA Through Email For Re-Registration Or
Registration Of New Domain Names. Otherwise, Please Continue Below. |
| Date Received: |
(YYYY/MM/DD)
Email Date Received By CIRA. Otherwise, Please Continue Below. |
| Number Of
Year(s) The Domain Name Will Be Registered: |
Please Choose How Many Years You Want The Domain Name(s) To Be Registered. The
Longer You Register, The More You Save! For More Savings On Bulk Domain Name
Registrations, Click Here! |
| Domain Name
Server Information: |
|
Domain Owner (Administrative Contact) Information |
| Prefix: |
|
First Name:
|
|
| Last
Name: |
|
|
|
|
| Company
Name: |
If It's Not A Company, Please Enter The First Name And The Last Name Of The Individual. |
|
|
| Preferred
Language: |
|
| Phone: |
|
| Fax
Number: |
|
| Other Phone: |
|
| Primary
E-mail: |
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| FULL
Mailing Address: |
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| Suite/Unit
No.: |
(i.e., Suite 111, Unit 111) |
| City: |
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| State/Province: |
If Outside Canada |
| Postal/ZipCode: |
|
| Country: |
|
Domain
Technical Contact Information |
NOTE:
|
Add Value International Inc.
Other
(If the "Other" Button Is Chosen, Please Provide Us Your Contact Info Below) |
| Prefix: |
|
| First Name: |
|
| Last Name: |
|
| Company:
|
(If Different
From Above, Fill Out The Following) |
| Job Title: |
|
| Preferred
Language: |
|
| Phone: |
|
| Fax Number: |
|
| Mobile Phone : |
|
| Primary
E-mail: |
|
| Secondary
E-mail: |
|
| Mailing Address: |
|
| Technical
Contact Mailing Address: |
|
| Suite/Unit
No.: |
(i.e., Suite 111, Unit 111) |
| City: |
|
| State/Province: |
If Outside Canada |
| Zip/Postal
Code: |
|
| Country: |
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| Electronic Signature: |
I Have Read And Agreed With CIRA's Registrant Agreement. |
Add
Value International Inc. provides this domain name registration service as one of our
services to the general public. Add Value International Inc. will do it's best to insure
uninterrupted service to your domain name. However, Add Value International Inc. cannot be
held liable whatsoever for any service interruptions to your domain name. You are
completely responsible for submitting any and all of the information requested on this
form accurately. Should your application for domain name registration be rejected by CIRA
for any reason(s), you will be notified directly to the e-mail address you have provided
on this application. It is your responsibility to acknowledge and agree with CIRA for the
registration of your domain name. You have up to 7 days to confirm with CIRA your
registration of your domain name or your domain name request will be returned to the pool
of names available for others to register. You may be requested to resubmit your
application again if the application on this form is incomplete. Registration fees are
NON-REFUNDABLE. Thank you for your co-operation.
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