.CA Domain Name Registration Form
Is this to register your existing .ca domain name?
IMPORTANT!
Please complete the following required fields .
Name:
Select From Below:
Aboriginal Peoples
Association
Canadian Corporation, Federally Or
Provincially Incorporated
Canadian Citizen Who Is Ordinarily
Resident In Canada
Canadian Educational Institute
Federal, Provincial, Territorial,
Municipal Or Local Government Or Agency
Hospital
Indian Band
Library, Archive Or Museum
Legal Representative
Her Majesty The Queen
Person Protected By Subsection 9(1) Of
The Trade-Marks Act (Canada)
Political Party
Partnership
Permanent Residant Within Meaning Of The
Immigration Act (Canada)
Owner Of A Trade-Mark Subject Of A
Registration Under The Trade-Marks Act (Canada)
Trade Union
Trust
Description
Of Registrant:
Brief Description (< 250 Characters Of The Domain Name )
.CA Domain:
Do you want to upgrade your
sub-domain name (i.e. yourcompany.on.ca) to a top level domain name (i.e. yourcompany.ca)?
If applicable to your existing domain name.
**To Register
Additional Domain Names, Please Fill The Following Fields. If Not, Please Continue To The
Next Section Below. For Great Savings On Registering 10 Or More Domain Names, Use The
"Bulk Registration Form "
.CA Domain:
.CA Domain:
.CA Domain:
.CA Domain:
.CA Domain:
.CA Domain:
.CA Domain:
.CA Domain:
.CA Domain:
Is The
Submitted Domain Name A Trademark?:
Do You Want To
Be A CIRA Member?:
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.
Reference
Information:
Date Received:
Number Of
Year(s) The Domain Name Will Be Registered:
2 - $89.95
1 - $49.95
3 - $129.95
4 - $169.95
5 - $199.95
6 - $229.95
7 - $259.95
8 - $289.95
9 - $319.95
10 - $349.95
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:
Domain Owner (Administrative Contact) Information
Prefix:
Choose from below
Mr.
Mrs.
Ms.
Dr.
Contact First Name Only:
Contact
Last Name Only:
Choose from below
Canadian
Foreign Citizenship
Canadian Resident
Company
Name:
Job Title of Contact Name :
Preferred
Language:
Choose from below
English
Français
Business
Phone:
Fax
Number:
Other Phone (cell, home, etc.):
Primary
E-mail:
Mailing
Address:
Suite or
Unit Number (if applicable)
City:
State/Province:
Zip/Postal
Code:
Country:
Canada
Aruba
Afghanistan
Angola
Anguilla
Albania
Andorra
Netherlands Antilles
United Arab Emirates
Argentina
Armenia
American Samoa
Antarctica
French Southern Territories
Antigua And Barbuda
Australia
Austria
Azerbaijan
Burundi
Belgium
Benin
Burkina Faso
Bangladesh
Bulgaria
Bahrain
Bahamas
Bosnia And Herzegowina
Belarus
Belize
Bermuda
Bolivia
Brazil
Barbados
Brunei Darussalam
Bhutan
Bouvet Island
Botswana
Central African Republic
Canada
Cocos Islands
Switzerland
Chile
China
Cote D'Ivoire
Cameroon
Congo, Democratic Republic of
Congo
Cook Islands
Columbia
Comoros
Cape Verde
Costa Rica
Cuba
Christmas Island
Cayman Islands
Cyprus
Czech Republic
Germany
Djibouti
Dominica
Denmark
Dominican Republic
Algeria
Egypt
Ecuador
Eritrea
Western Sahara
Spain
Estonia
Ethiopia
Finland
Fiji
Falkland Islands
France
Faroe Islands
Micronesia
France Metropolitan
Gabon
United Kingdom
Georgia
Ghana
Gibraltar
Guinea
Guadeloupe
Gambia
Guinea-Bissau
Equatorial Guinea
Greece
Grenada
Greenland
Guatemala
French Guiana
Guam
Guyana
Hong Kong
Heard and McDonald Islands
Honduras
Croatia
Haiti
Hungary
Indonesia
India
British Indian Ocean Territory
Ireland
Iran
Iraq
Iceland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Saint Kitts and Nevis
Korea, Republic of
Kuwait
Laos
Lebanon
Liberia
Libya
Saint Lucia
Liechtenstein
Sri Lanka
Lesotho
Lithuania
Luxembourg
Latvia
Macao
Morocco
Monaco
Moldova
Madagascar
Maldives
Mexico
Marshall Islands
Macedonia
Mali
Malta
Myanmar
Mongolia
Northern Mariana Islands
Mozambique
Mauritania
Montserrat
Martinique
Mauritius
Malawi
Malaysia
Mayotte
Namibia
New caledonia
Niger
Norfolk island
Nigeria
Nicaragua
Niue
Netherlands
Norway
Nepal
Nauru
New Zealand
Oman
Pakistan
Panama
Pitcairn
Peru
Philippines
Palau
Papua New Guinea
Poland
Puerto Rico
Korea, Democratic People's Republic
Portugal
Paraguay
Palestinian Territory
French Polynesia
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Sudan
Senegal
Singapore
South Georgia And The South Sand
St. Helena
Svalbard and Jan Mayen Islands
Solomon Islands
Sierra Leone
El Salvador
San Marino
Somalia
St. Pierre and Miquelon
Sao Tome and Principe
Suriname
Slovakia
Slovenia
Sweden
Swaziland
Seychelles
Syria
Turks and Caicos islands
Chad
Togo
Thailand
Tajikistan
Tokelau
Turkmenistan
East Timor
Tonga
Trinidad and Tobago
Tunisia
Turkey
Tuvalu
Taiwan
Tanzania
Uganda
Ukrenia
Uruguay
United States of America
Uzbekistan
Vatican City State
Saint Vincent and the Grenadines
Venezuela
Virgin Islands (British)
Virgin Islands (U.S.)
Viet Nam
Vanuatu
Wallis and Futuna Islands
Samoa
Yemen
Yugoslavia
South Africa
Zambia
Zimbabwe
Domain
Technical Contact Information
NOTE:
Prefix:
Choose from below
Mr.
Mrs.
Ms.
Dr.
Technical
Contact First Name:
Technical
Contact Last Name:
Technical
Contact Company:
Technical
Contact Job Title:
Preferred
Language:
Choose from below
English
Français
Technical
Contact Phone:
Fax Number:
Ohter Phone (cell, home, etc.):
Primary
E-mail:
Secondary E-mail:
Technical Contact Mailing Address:
Technical
Contact Mailing Address:
Suite or Unit
Number (if applicable):
City:
State/Province:
Zip/Postal
Code:
Country:
Canada
Aruba
Afghanistan
Angola
Anguilla
Albania
Andorra
Netherlands Antilles
United Arab Emirates
Argentina
Armenia
American Samoa
Antarctica
French Southern Territories
Antigua And Barbuda
Australia
Austria
Azerbaijan
Burundi
Belgium
Benin
Burkina Faso
Bangladesh
Bulgaria
Bahrain
Bahamas
Bosnia And Herzegowina
Belarus
Belize
Bermuda
Bolivia
Brazil
Barbados
Brunei Darussalam
Bhutan
Bouvet Island
Botswana
Central African Republic
Canada
Cocos Islands
Switzerland
Chile
China
Cote D'Ivoire
Cameroon
Congo, Democratic Republic of
Congo
Cook Islands
Columbia
Comoros
Cape Verde
Costa Rica
Cuba
Christmas Island
Cayman Islands
Cyprus
Czech Republic
Germany
Djibouti
Dominica
Denmark
Dominican Republic
Algeria
Egypt
Ecuador
Eritrea
Western Sahara
Spain
Estonia
Ethiopia
Finland
Fiji
Falkland Islands
France
Faroe Islands
Micronesia
France Metropolitan
Gabon
United Kingdom
Georgia
Ghana
Gibraltar
Guinea
Guadeloupe
Gambia
Guinea-Bissau
Equatorial Guinea
Greece
Grenada
Greenland
Guatemala
French Guiana
Guam
Guyana
Hong Kong
Heard and McDonald Islands
Honduras
Croatia
Haiti
Hungary
Indonesia
India
British Indian Ocean Territory
Ireland
Iran
Iraq
Iceland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Saint Kitts and Nevis
Korea, Republic of
Kuwait
Laos
Lebanon
Liberia
Libya
Saint Lucia
Liechtenstein
Sri Lanka
Lesotho
Lithuania
Luxembourg
Latvia
Macao
Morocco
Monaco
Moldova
Madagascar
Maldives
Mexico
Marshall Islands
Macedonia
Mali
Malta
Myanmar
Mongolia
Northern Mariana Islands
Mozambique
Mauritania
Montserrat
Martinique
Mauritius
Malawi
Malaysia
Mayotte
Namibia
New caledonia
Niger
Norfolk island
Nigeria
Nicaragua
Niue
Netherlands
Norway
Nepal
Nauru
New Zealand
Oman
Pakistan
Panama
Pitcairn
Peru
Philippines
Palau
Papua New Guinea
Poland
Puerto Rico
Korea, Democratic People's Republic
Portugal
Paraguay
Palestinian Territory
French Polynesia
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Sudan
Senegal
Singapore
South Georgia And The South Sand
St. Helena
Svalbard and Jan Mayen Islands
Solomon Islands
Sierra Leone
El Salvador
San Marino
Somalia
St. Pierre and Miquelon
Sao Tome and Principe
Suriname
Slovakia
Slovenia
Sweden
Swaziland
Seychelles
Syria
Turks and Caicos islands
Chad
Togo
Thailand
Tajikistan
Tokelau
Turkmenistan
East Timor
Tonga
Trinidad and Tobago
Tunisia
Turkey
Tuvalu
Taiwan
Tanzania
Uganda
Ukrenia
Uruguay
United States of America
Uzbekistan
Vatican City State
Saint Vincent and the Grenadines
Venezuela
Virgin Islands (British)
Virgin Islands (U.S.)
Viet Nam
Vanuatu
Wallis and Futuna Islands
Samoa
Yemen
Yugoslavia
South Africa
Zambia
Zimbabwe
Electronic
Signature:
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.