.ca registration - Bulk Domain Name Registration Form

Bulk Domain Name Registration Form

IMPORTANT! Please Complete The Following Required Fields Marked In Red.

Organization Information

Registrant Name:

If It's Not A Company, Please Enter The First Name And The Last Name Of The Individual.

Organization Type:

(Choose Type)

Description of Registrant (Optional):

Brief Description (< 250 Characters Of The Domain Name )

10 Domain Names:

Enter your domain names here:
(Include .ca Canada, .ab.ca Canada Regional, .bc.ca Canada Regional, .mb.ca Canada Regional, .nb.ca Canada Regional, .nf.ca Canada Regional, .ns.ca Canada Regional, .nt.ca Canada Regional, .on.ca Canada Regional, .pe.ca Canada Regional, .qc.ca Canada Regional, .sk.ca Canada Regional, or .yk.ca Canada Regional)

25 Domain Names:

50 Domain Names:

100 Domain Names:

Is The Submitted Domain Name A Trademark?:

Yes
No

Do You Want To Be A CIRA Member?:

Yes
No

CIRA Is The Non-Profit Organization That Runs The Canadian .CA Domain Name Registry. Membership Gives You The Right To Vote In Elections And Referendums.

Number Of Year(s) The Domain Name Will Be Registered:

(Choose Term)
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:

	Use Add Value International Server Information
	Other ISP - If Other, Please Erase And Fill In Your ISP Info Below
	Primary DNS Server Host Name
	Primary I.P. Address Numbers
	Secondary DNS Server Host Name
	Secondary I.P. Address Numbers

Administrative Contact

First Name:

Last Name:

Nationality:

(Choose Nationality)

Company Name:

If It's Not A Company, Please Enter The First Name And The Last Name Of The Individual.

Job Title:

Preferred Language:

(Choose Preference)

Business Phone:

Please include your area code and extension.

Fax Number:

Please include your area code.

Other Phone (Cell, home, etc.):

Please include your area code.

Primary E-mail:

A valid email address where your domain name confirmation and any information will be sent to.

Secondary E-mail:

A backup email address for us to use in case your primary email is down.

Mailing Address:

Suite/Unit No.:

(i.e., Suite 111, Unit 111)

City:

State/Province:

If Outside Canada

Zip/Postal Code:

Country:

Technical Contact

NOTE:

Use Add Value International Inc. As Technical Contact
Use Another Contact (If the "Other" Button Is Chosen, Please Provide Us Your Contact Info Below)

First Name:

Last Name:

Company Name:

(If Different From Above, Fill Out The Following)

Job Title:

Preferred language:

(Choose Preference)

Phone:

Please include your area code and extension.

Fax:

Please include your area code.

Other Phone (cell, home, etc.):

Please include your area code.

Primary E-mail:

A valid email address is require for any technical corespondents.

Secondary E-mail:

A backup email address is require for any technical corespondents.

Mailing Address:

	Same As The Administrative Contact
	A Different Address

Mailing Address:

Suite/Unit No.:

(i.e., Suite 111, Unit 111)

City:

State/Province:

If Outside Canada

Zip/Postal Code:

Country:

I Would Like To Receive My Billing Invoice Via My:

E-mail Postal Address

Electronic Signature:

I Have Read And Agreed With CIRA's Registrant Agreement.

***Disclaimer***

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.