domain registration form - canreg.com · domain registration form please complete this form in full...
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DOMAIN REGISTRATION FORM
Please complete this form in full to registeryour .CA domain. You may search fordomain availability at www.canreg.comPlease note that registrations will only beprocessed once the form and paymenthave been received. CanReg.com cannotguarantee that the name you are applyingfor will still be available at the time thisapplication is received.
IMPORTANT - Please make chequespayable to our parent company:Infinet Communications Group
ONWERSHIP INFORMATION
Domain Name :
Legal Owner :
Term (Years) :
Last Name :
First Name :
Address :
City :
State/Province :
Country :
Zip/Postal Code :
Phone :
Fax :
Email :
ADMIN / BILLING CONTACT INFORMATION
Primary Host :
Primary IP :
Seconday Host :
Secondary IP :
DOMAIN NAME SERVER INFORMATION
If you are unsure of your DNS settings or have notyet found a hosting provider leave these fields blankto recieve a free under construction page. DNS mayalways be updated any time without charge.
REGISTRATION PRICING
INSTRUCTIONS
CanReg.com Suite 104 - 12761 16th AveSurrey, B.C.V4A 1N2http://[email protected]
CANREG CONTACT INFO
AUTHORIZATION
I certify that I am an authorized signatoryfor the registration of this domain nameand agree with the registration termsspecified at http://www.canreg.com/agree
Signature :
Date :
MULTI-YEAR DISCOUNTS
TERM(Years)
PRICE/YR(CAD$)
TOTAL(inc. H ST)
1 Year
2 years
5 years
10 years
$29.95
$24.95
$19.95
$16.95
$33.54
$55.89
$111.72
$189.84
canReg.comAN INFINET.NET DIVISION
2 1 5 10(standard)