{{heading}} - Order Form
Congratulations on your decision to move forward with your business and register your own 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.
{{syntax_error_msg}}
{{CC_FIELDS}}
{{AUTO_RENEW}}
Domain Information
Domains:
Registration Period: (min 2 years for .us)
Profile: {{reg_profile}}

{{CUSTOM_TECH_CONTACT}} {{CUSTOM_NAMESERVERS}}
Registration Type: {{reg_type_text}}
.ASIA CED Contact Information
Contact Type

Charter Eligibility is the basic requirement to register a .ASIA domain name, at least one of the domain contacts (admin, billing, owner/registrant, tech) must be a legal entity in the DotAsia Community.
Country/Locality  [-]
City
*optional*
State/Province
*optional*
Legal Entity Type
Identification Type
     Type:
Identification Number
Owner Contact Information
First Name:
Last Name:
Organization Name:
Street Address:
*optional* (eg: Suite #245):
*optional* Address 3:
City:
State:
Country:
Postal Code:
Phone Number:
(eg. +1.4165551122x333)*
*optional* Fax Number:
(eg. +1.4165551122)*
Email:
Must be currently valid address
Admin Contact Information
Same as Owner Information
First Name:
Last Name:
Organization Name:
Street Address:
*optional* (eg: Suite #245):
*optional* Address 3:
City:
State:
Country:
Postal Code:
Phone Number:
(eg. +1.4165551122x333)*
*optional* Fax Number:
(eg. +1.4165551122)*
Email:
Must be currently valid address
Billing Contact Information
Same as Owner Information
Same as Admin Information
If both checkboxes are selected, 'Owner Information' checkbox will be default.
First Name:
Last Name:
Organization Name:
Street Address:
*optional* (eg: Suite #245):
*optional* Address 3:
City:
State:
Country:
Postal Code:
Phone Number:
(eg. +1.4165551122x333)*
*optional* Fax Number:
(eg. +1.4165551122)*
Email:
Must be currently valid address


* - Phone and fax formats are as follows (extention is optional):
    +{country_dialing_code}.{phone_number}[x{extension}]
    eg. "+44.02055511928"