<center>

Step 1: Digital Certificate Product Selection.<br>
Step 2: Enter Product Order Details.<br>
<b>Step 3: Credit Card Information. Order Confirmation.</b><br>
<p>

<form action="<TMPL_VAR NAME=cgi>" method="post">
<input type=hidden name="action" value="register">
<input type=hidden name="reg_type" value="<TMPL_VAR NAME=reg_type>">
<input type=hidden name="id" value="<TMPL_VAR NAME=id>">

<table border="0" cellpadding="5" cellspacing="1">
<tr>
    <td class="main" colspan=2 align=center>
	<font class="heading">New Digital Certificate Order Form</font>
    </td>
</tr>

<tr>
    <td class="accent" align="center" colspan=2><b>Product Information</b></td>
</tr>
<tr>
    <td class="accent" align="right">Product:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=product_name>
	<input type=hidden name="product" value="<TMPL_VAR NAME=product>">
    </td>
</tr>

<TMPL_IF domain>
<tr>
    <td class="accent" align="right">Domain:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=domain>
	<input type=hidden name="domain" value="<TMPL_VAR NAME=domain>">
    </td>
</tr>
</TMPL_IF>

<TMPL_IF approver_email>
<tr>
    <td class="accent" align="right">Approver E-mail:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=approver_email>
	<input type=hidden name="approver_email"
	    value="<TMPL_VAR NAME=approver_email>">
    </td>
</tr>
</TMPL_IF>

<tr>
    <td class="accent" align="right">Period:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=period>
	<input type=hidden name="period" value="<TMPL_VAR NAME=period>">
    </td>
</tr>

<TMPL_IF organization_contact>
<tr>
    <td class="accent" align=center colspan=2><b>Organization Contact</b>
	<input type=hidden name="organization_contact_id"
	    value="<TMPL_VAR NAME=organization_contact_id>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Organization Legal Name:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_org_name>
	<input type=hidden name="organization_org_name"
	    value="<TMPL_VAR NAME=organization_org_name>">
    </td>
</tr>
<TMPL_IF organization_duns>
<tr>
    <td class="accent" align="right">DUNS Number:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_duns>
	<input type=hidden name="organization_duns"
	    value="<TMPL_VAR NAME=organization_duns>">
    </td>
</tr>
</TMPL_IF>
<tr>
    <td class="accent" align="right">Street Address 1:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_address1>
	<input type=hidden name="organization_address1"
	    value="<TMPL_VAR NAME=organization_address1>">
    </td>
</tr>
<TMPL_IF organization_address2>
<tr>
    <td class="accent" align="right">Street Address 2:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_address2>
	<input type=hidden name="organization_address2"
	    value="<TMPL_VAR NAME=organization_address2>">
    </td>
</tr>
</TMPL_IF>
<TMPL_IF organization_address3>
<tr>
    <td class="accent" align="right">Street Address 3:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_address3>
	<input type=hidden name="organization_address3"
	    value="<TMPL_VAR NAME=organization_address3>">
    </td>
</tr>
</TMPL_IF>
<tr>
    <td class="accent" align="right">City:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_city>
	<input type=hidden name="organization_city"
	    value="<TMPL_VAR NAME=organization_city>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">State/Province:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_state>
	<input type=hidden name="organization_state"
	    value="<TMPL_VAR NAME=organization_state>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Zip/Postal Code:</td>
    <td class="accent" align=left><TMPL_VAR NAME=organization_postal_code>
	<input type=hidden name="organization_postal_code"
	    value="<TMPL_VAR NAME=organization_postal_code>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Country:</td>
    <td class=accent align=left><TMPL_VAR NAME=organization_country_name>
	<input type=hidden name="organization_country"
	    value="<TMPL_VAR NAME=organization_country>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Phone:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_phone>
	<input type=hidden name="organization_phone"
	    value="<TMPL_VAR NAME=organization_phone>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Fax:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=organization_fax>
	<input type=hidden name="organization_fax"
	    value="<TMPL_VAR NAME=organization_fax>">
    </td>
</tr>
</TMPL_IF>

<tr>
    <td class="accent" align="center" colspan=2><b>Certificate Admin.
	Contact</b><input type=hidden name="admin_contact_id"
	    value="<TMPL_VAR NAME=admin_contact_id>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">First Name:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_first_name>
	<input type=hidden name="admin_first_name"
	    value="<TMPL_VAR NAME=admin_first_name>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Last Name:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_last_name>
	<input type=hidden name="admin_last_name"
	    value="<TMPL_VAR NAME=admin_last_name>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Street Address:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_address1>
	<input type=hidden name="admin_address1"
	    value="<TMPL_VAR NAME=admin_address1>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">City:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_city>
	<input type=hidden name="admin_city"
	    value="<TMPL_VAR NAME=admin_city>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">State/Province:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_state>
	<input type=hidden name="admin_state"
	    value="<TMPL_VAR NAME=admin_state>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Zip/Postal Code:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_postal_code>
	<input type=hidden name="admin_postal_code"
	    value="<TMPL_VAR NAME=admin_postal_code>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Country:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_country_name>
	<input type=hidden name="admin_country"
	    value="<TMPL_VAR NAME=admin_country>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Phone:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_phone>
	<input type=hidden name="admin_phone"
	    value="<TMPL_VAR NAME=admin_phone>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Email:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=admin_email>
	<input type=hidden name="admin_email"
	    value="<TMPL_VAR NAME=admin_email>">
    </td>
</tr>

<tr>
    <td class="accent" align="center" colspan=2><b>Certificate Billing
	Contact</b><input type=hidden name="billing_contact_id"
	    value="<TMPL_VAR NAME=billing_contact_id>">
    </td>
</tr>
<TMPL_IF billing_as_admin>
<tr>
    <td class="accent" align="center" colspan=2>Same as Admin. contact
	<input type=hidden name="billing_as_admin" value="1">
    </td>
</tr>
<TMPL_ELSE>
<tr>
    <td class="accent" align="right">First Name:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_first_name>
	<input type=hidden name="billing_first_name"
	    value="<TMPL_VAR NAME=billing_first_name>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Last Name:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_last_name>
	<input type=hidden name="billing_last_name"
	    value="<TMPL_VAR NAME=billing_last_name>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Street Address:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_address1>
	<input type=hidden name="billing_address1"
	    value="<TMPL_VAR NAME=billing_address1>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">City:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_city>
	<input type=hidden name="billing_city"
	    value="<TMPL_VAR NAME=billing_city>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">State/Province:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_state>
	<input type=hidden name="billing_state"
	    value="<TMPL_VAR NAME=billing_state>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Zip/Postal Code:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_postal_code>
	<input type=hidden name="billing_postal_code"
	    value="<TMPL_VAR NAME=billing_postal_code>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Country:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_country_name>
	<input type=hidden name="billing_country"
	    value="<TMPL_VAR NAME=billing_country>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Phone:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_phone>
	<input type=hidden name="billing_phone"
	    value="<TMPL_VAR NAME=billing_phone>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Email:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=billing_email>
	<input type=hidden name="billing_email"
	    value="<TMPL_VAR NAME=billing_email>">
    </td>
</tr>
</TMPL_IF>

<tr>
    <td class="accent" align="center" colspan=2><b>Certificate Technical
	Contact</b><input type=hidden name="tech_contact_id"
	    value="<TMPL_VAR NAME=tech_contact_id>">
    </td>
</tr>
<TMPL_IF tech_as_admin>
<tr>
    <td class="accent" align="center" colspan=2>Same as Admin. Contact
	<input type=hidden name="tech_as_admin" value="1">
    </td>
</tr>
<TMPL_ELSE>
    <TMPL_IF tech_as_billing>
    <td class="accent" align="center" colspan=2>Same as Billing Contact
	<input type=hidden name="tech_as_billing" value="1">
    </td> 
    <TMPL_ELSE>
<tr>
    <td class="accent" align="right">First Name:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_first_name>
	<input type=hidden name="tech_first_name"
	    value="<TMPL_VAR NAME=tech_first_name>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Last Name:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_last_name>
	<input type=hidden name="tech_last_name"
	    value="<TMPL_VAR NAME=tech_last_name>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Street Address:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_address1>
	<input type=hidden name="tech_address1"
	    value="<TMPL_VAR NAME=tech_address1>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">City:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_city>
	<input type=hidden name="tech_city" value="<TMPL_VAR NAME=tech_city>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">State/Province:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_state>
	<input type=hidden name="tech_state"
	    value="<TMPL_VAR NAME=tech_state>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Zip/Postal Code:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_postal_code>
	<input type=hidden name="tech_postal_code"
	    value="<TMPL_VAR NAME=tech_postal_code>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Country:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_country_name>
	<input type=hidden name="tech_country"
	    value="<TMPL_VAR NAME=tech_country>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Phone:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_phone>
	<input type=hidden name="tech_phone"
	    value="<TMPL_VAR NAME=tech_phone>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Email:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=tech_email>
	<input type=hidden name="tech_email"
	    value="<TMPL_VAR NAME=tech_email>">
    </td>
</tr>

    </TMPL_IF>
</TMPL_IF>

<tr>
    <td class="accent" align="center" colspan=2><b>Certificate Signing Request
	Information</b></td>
</tr>
<tr>
    <td class="accent" valign="top" align="right">CSR:</td>
    <td class="accent" align="left">
    <TMPL_IF csr>
	<pre><TMPL_VAR NAME=csr></pre>
    <TMPL_ELSE>
	None
    </TMPL_IF>
	<input type=hidden name="csr" value="<TMPL_VAR NAME=csr>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Web Server:</td>
    <td class="accent" align="left"><TMPL_VAR NAME=webserver_name>
	<input type=hidden name="webserver" value="<TMPL_VAR NAME=webserver>">
    </td>
</tr>
<tr>
    <td class="accent" align="right">Special Instructions:</td>
    <td class="accent" align="left">
    <TMPL_IF special_instructions>
	<TMPL_VAR NAME=special_instructions>
    <TMPL_ELSE>
	None
    </TMPL_IF>
	<input type=hidden name="special_instructions"
	    value="<TMPL_VAR NAME=special_instructions>">
    </td>
</tr>

<TMPL_IF show_cc_fields>

<tr>
    <td class="accent" align="center" colspan=2><b>Credit Card
	Information</b><br>
	<font color=red><b>Please ensure you are obtaining payment with the
	information gathered.<br>
	This template does no credit card processing by default.</b></font>
	
	
    </td>
</tr>
<tr>
    <td class="accent" align="right">Credit Card:</td>
    <td class="accent" align="left"><select name=cc_type>
	    <TMPL_VAR NAME=cc_type_select>
	</select>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Card Holder Name:</td>
    <td class="accent" align="left"><input type=textbox name="cc_name"
	value="" size=20></td>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Card Number:</td>
    <td class="accent" align="left"><input type=textbox name="cc_num"
	value="" size=20></td>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Expiry Date:</td>
    <td class="accent" align="left"><select name=cc_mon>
	    <TMPL_VAR NAME=cc_month_select>
	</select>-
	<select name=cc_year>
	    <TMPL_VAR NAME=cc_year_select>
	</select>	
    </td>
</tr>

</TMPL_IF>

<tr>
    <td class="main" align="center" colspan="2">
	<input type="submit" name="btnConfirm" value=" Confirm ">&nbsp;&nbsp;
	<input type="submit" name="btnEdit" value=" Edit ">
    </td>
</tr>

</table>

</form>

</center>
