.CA {{heading}} - 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 the domains in the batch below will be added to ONE Registrant Profile at CIRA. The names will also be in the same profile for contact and DNS management.

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Domain Information
Domains:
Registration Period:
Profile: The names above will be added to the CIRA Registrant Profile that contains the name {{reg_domain}} 
Owner name {{owner_org_name}} 
Owner Description (max 2000 characters) {{domain_description}}  
Are these domains registered trade-marks? No  Yes
Language Preference:
{{CUSTOM_TECH_CONTACT}} {{CUSTOM_NAMESERVERS}}
Registration Type: {{reg_type_text}}
Admin Contact Information
First Name: {{admin_first_name}} 
Last Name: {{admin_last_name}} 
Organization Name: {{admin_org_name}} 
Street Address: {{admin_address1}} 
City: {{admin_city}} 
State: {{admin_state}} 
Country: {{admin_country}} 
Postal Code: {{admin_postal_code}} 
Phone Number: {{admin_phone}} 
Fax Number: {{admin_fax}} 
Email: {{admin_email}}