.CA Domain {{reg_text}} - Order Form
Congratulations on your decision to move forward with your business and register your own .CA domain name. Upon completing the form below, you will be brought to a second page where you may verify that all of the information you have provided is correct. After you approve the information, simply click the "Order It!" button and you're done.

Please note that by CIRA request, you must have a presence in Canada in order to qualify for a .CA domain. This means that at least one of your contacts must be located in Canada.

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Domain Information
Domains Desired: {{domains}}
Registration Period:
Profile: {{reg_profile}}
NOTE: If an existing .ca domain, username and password are included in this section, then OpenSRS will ignore registration information included in this form, and the name will simply be added to the existing Registrant Profile at CIRA.
Organization Name:
Owner Description
(max 2000 characters)
Is this domain a registered trade-mark? No  Yes
Language Preference:
Legal Type:
Become CIRA Member: Yes No
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Registration Type: {{reg_type_text}}
Admin Information
First Name:
Last Name:
Organization Name:
Street Address:
City:
Province: (If in Canada, please use AB, ON, QC, etc)
Country:
Postal Code:
Phone Number:
(eg. 416-555-1122 x333)
*optional* Fax Number:
(eg. 416-555-1122)
Email:
Must be currently valid address

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