<HTML>
<HEAD><TITLE>WHOIS Privacy Order Form</TITLE>
<meta http-equiv="Content-type" content="text/html; charset=UTF-8">
</HEAD>
<BODY bgcolor="#ffffff">
<BR>
<center>

<form name="mainform" method="post" action="{{CGI}}">
<input type="hidden" name="affiliate_id" value="{{affiliate_id}}">
<input type="hidden" name="reg_type" value="whois_privacy">
<input type="hidden" name="action" value="wp_register">
<input type="hidden" name="reg_domain" value="{{reg_domain}}">
<table border=0 cellpadding=2 cellspacing=0 width=580>
<tr><td align=center>
<font face="verdana, arial" size=3>
<strong>STANDALONE<br>WHOIS Privacy Service Order</strong></font><br><br></td></tr>
<tr>
    <td>
     <table width="580" border="1">
     <tr bgcolor="#90c0ff">
     <td align=center nowrap><b>Domain Name</b></td>
	 <td align=center><b>Action</b></td>
     </tr>
     <tr>
        <td align=center ><b>{{reg_domain}}</b></td>
        <td align="center"> Process Order </td>
     </tr> 
     <tr>
        <td colspan="2" align="center">
            <input type="submit" name="submit" value="  Order Now !  ">
	</td>
     </tr>
     </table>

  </td>
</tr>
</table>
<br><font size=-1 color="red">* <i>( only applicable for .com, .net, .org, .biz, .cc, .tv, .info, and .asia domains ) </i></font>
<br>
</form>
<A HREF="{{CGI}}?action=logout">Logout</A>
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</BODY>
</HTML>




