<center><Font size=+2><B><font color=red>.CA</font> Domain {{reg_text}} - Order Form</B></FONT></center>

<BLOCKQUOTE>
Congratulations on your decision to move forward with your business 
and transfer your existing <font color=red>.CA</font> domain name to us.  
Upon completing the form below, you will be brought to a second 
page where you may verify that all of the information you have
provided is correct.
After you approve the information, simply click the "Order It!" 
button and you're done.
<P>
<I>Please note that there is no ownership changes allowed within .CA transfer</I><P>
</BLOCKQUOTE>

<center><FONT color = red><B>{{syntax_error_msg}} </B></FONT></center>
<CENTER>
<table border=1>

<form method=post action="{{CGI}}">

<TR><TD>

<!--Begin revision and colored table-->

<TABLE BORDER=0 width=550>
<TR>
	<TD ALIGN=center colspan=2 bgcolor="#e0e0e0">
		<B><FONT SIZE=+1>Domain Information</FONT></B>
	</TD>
</TR>
<TR>
	<TD ALIGN=right bgcolor="#e0e0e0"><B>Domains to Trasnfer:</B></TD>
	<TD>{{domains}}</TD>
</TR>
<TR>
        <TD align=right bgcolor="#e0e0e0"><b>Registration Period:</b></td>
        <TD><select name=period>
            {{PERIOD_LIST}}
            </select>
        </TD>
</TR>
<TR>
	<TD bgcolor="#e0e0e0" align=right><B>Profile:</B></td>
	<TD>{{reg_profile}}</td>
</tr>
</TABLE>
</TD></TR>

{{CC_FIELDS}}

<TR><TD>

<table width=100%>
<tr>
	<th><INPUT TYPE="submit" VALUE=" V E R I F Y    O R D E R "></th>
	<th><INPUT TYPE="reset" value=" C L E A R "></th>
</tr>
</table>

</table>
<BR>
</CENTER>

<input type=hidden name=affiliate_id value="{{affiliate_id}}">
<input type=hidden name=action value=verify_order>
{{domain_string}}
<input type=hidden name=reg_username value="{{reg_username}}">
<input type=hidden name=reg_password value="{{reg_password}}">
<input type=hidden name=reg_domain value="{{reg_domain}}">
<input type=hidden name=reg_type value="{{reg_type}}">
<input type=hidden name=old_domain value="{{old_domain}}">
<input type=hidden name=bulk_order value="{{bulk_order}}">
</form>
<BR>
