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Step 2: Registration Form
Step 3: Instructions To Confirm With CIRA
Registration Agreement
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Domain Name
Renewal
For .COM Registration
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For (.COM), (.NET), (.ORG), (.INFO) & (.BIZ) Renewals & Transfers

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Canadian Federation of Independent Business

Missisauga Board of Trade

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International
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Domain Name Registration Form

Please Complete The Following. Required Fields Marked In Red.
Organization Information
Registrant Name:

(i.e. Company Name Or Individual Name)

Organization Type:

Registration Requirements
Description Of Registrant (Optional):

 
Brief Description (< 250 Characters Of The Domain Name )

Domain Name To Register:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
.CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
 .CA Domain:


Enter Your Domain Name And Select The Extension From The Drop-Down Menu.
Is The Submitted Domain Name A Trademark?:

Yes
No
Number Of Year(s) The Domain Name Will Be Registered:

(Please Choose Term)
Prices Shown Is The Normal Registration Price.

Domain Name Server Information:
Use Add Value International Server Information.
(If You Have Not Yet Develop Your Web Site Or Do Not Have A Hosting Provider, Please Use Our Server Information.)
Other ISP - If Other, Please Erase And Fill In Your ISP Info Below.
DNS1 Name IP Address
DNS2 Name IP Address
DNS3 Name IP Address
DNS4 Name IP Address
DNS5 Name IP Address
DNS6 Name IP Address

Administrative Contact
First Name:
Last Name:

Nationality:

Company Name:

Job Title:

Preferred Language:

Business Phone:

Area Code :   Phone:   Important Administrative Contact Telephone Info
Please Include your Extension.
Fax Number:

Area Code :      Fax :
Please Include Your Area Code.
Other Phone :

Area Code :    Phone:
Please Include Your Area Code.
Mobile Phone :

Area Code :    Phone:
Please Include Your Area Code.
Primary E-mail:


Please Provide An Active Valid Email Address For Your Domain Name Confirmation And Any Information Will Be Sent To.

Secondary E-mail:


Please Provide A Backup Email Address In Case Your Primary Email Is Not Functioning.
Mailing Address:

Suite Or Unit Number (If Applicable)

(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
(If You Do Not Have A Technical Person, Please Use Add Value International As Your Technical Contact.)
Use Another Contact Name (If The "Other" Button Is Chosen, Please Erase And Provide Us Your Contact Info Below.)
First Name:

Last Name:

Company::


(If Different From Above, Fill Out The Following)
Job Title:

Preferred Language:

Business Phone:

Area Code :    Phone: 
Please Include your Extension.
Fax Number:

Area Code :       Fax :
Please Include Your Area Code.
Other Phone :

Area Code :    Phone:
Please Include Your Area Code.
Mobile Phone :

Area Code :    Phone:
Please Include Your Area Code.
Primary E-mail:


A Valid Email Address Is Required For Any Technical Corespondents.
Secondary E-mail:


A Backup Email Address Is Required For Any Technical Corespondents.
Technical Contact Mailing Address:
Same As The Administrative Contact
A Different Address
Technical Contact Mailing Address:

Suite or Unit Number (if applicable):

(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 Fax
Electronic Signature:
I Have Read And Agreed With CIRA's Registrant Agreement and Add Value International Disclaimer.

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This site is owned and operated by Add Value International Inc., a CIRA Certified Registrar for .CA Domain Name Registration in Canada.