<TMPL_INCLUDE header.html>
<center>
<font size=+3>.CA Domain Registration Form</font>
</center>

<table border=1>
<tr><td>

<table border=0 width=550 align=center>
  <tr bgcolor=#90c0ff>
    <th align=center colspan=2><font size=+1>Chosen Domain Name: <TMPL_VAR DOMAIN> </font></th>
  </tr>

  <tr bgcolor=#e0e0e0>
    <th align=right><TMPL_IF error_period><blink><font color=red>*</font></blink></TMPL_IF>Registration Period:</th>
    <td align="left">
      <select name=period>
      <TMPL_IF PERIOD>
        <option value="<TMPL_VAR PERIOD>" SELECTED> <TMPL_VAR PERIOD>
      </TMPL_IF>
        <option> 1
        <option> 2
        <option> 3
        <option> 4
        <option> 5
        <option> 6
        <option> 7
        <option> 8
        <option> 9
        <option> 10
      </select> Year(s)
    </td>
  </tr>

  <TMPL_IF allow_auto_renew>
  <tr bgcolor=#e0e0e0>
    <td>
      <font color=red>
	********ATTENTION********<br>
	A payment system must be implemented before
	giving your customers access to turn auto renew
	on for a new domain.
      </font> <br>
      Auto Renew:
    </td>
    <td>
    <TMPL_IF auto_renew>
      <input type=radio name=auto_renew value=1 checked> Yes<br>
      <input type=radio name=auto_renew value=0 > No<br>
    <TMPL_ELSE>
      <input type=radio name=auto_renew value=1 > Yes<br>
      <input type=radio name=auto_renew value=0 checked> No<br>
    </TMPL_IF>
    </td>
  </tr>
  </TMPL_IF>
</table>

<table width=550>

  <tr bgcolor=#90c0ff>
    <th align="center" colspan=2><font size=+1>Supplementary Domain Information</font></th>
  </tr>

  <tr bgcolor=#e0e0e0>
    <th aligh=left><b>Is this domain a registered trademark?</b></th>
    <td>
    <TMPL_IF ISA_TRADEMARK>
      <input type=radio name=isa_trademark value=1 checked>Yes
      <input type=radio name=isa_trademark value=0>No
    <TMPL_ELSE>
      <input type=radio name=isa_trademark value=1>Yes
      <input type=radio name=isa_trademark value=0 checked>No
    </TMPL_IF>
    </td>
  </tr>

  <tr bgcolor=#e0e0e0>
    <th width=50% align="left"><b>Add domain to existing CIRA profile 
      <a href="help.cgi?tld=ca&topic=ca_profile" target=help><img src="<TMPL_VAR CGI>?action=help_icon" alt="?" border=0></a></b></th>&nbsp;
    <td>
      <TMPL_IF linked>
        <input type=radio name=linked value=1 checked>Yes&nbsp;
        <input type=radio name=linked value=0>No
      <TMPL_ELSE><input type=radio name=linked value=1>Yes&nbsp;
        <input type=radio name=linked value=0 checked>No
      </TMPL_IF>
    </td>
  </tr>
  
</table>

<table border=0 cellspacing=0 cellpadding=1 width=100%>
  <tr>
    <td align=left>
      <input type=submit value="  Next  ">
    <th> For Help press <img src="<TMPL_VAR CGI>?action=help_icon" alt="?" border=0> in the above section  </th>
    </td>
    <td align=right>
      <input type="hidden" name="action" value="legal_type_quiz">
      <input type=submit name='back' value="  Back  ">
    </td>
  </tr>
</table>



</td></tr>
</table>
<TMPL_INCLUDE footer.html>

