Secure Domain Name Registration Form

Please fill in the secure form bellow. Your information will be sent to us and we will acknowledge your request either via email or telephone. The information provided here will be used to register this domain name please make sure it is accurate. Once registered any changes to the information below will be at an additional charge. Read Carefully 

Name: Address:
Company City:       
Prov./State               Postal/Zip  Phone (H) 
(Business)  Fax    Email Address **
The email address here must be your real address. The one provided to you by you ISP NOT your free address at hotmail etc.
Requested Domain Name

Fees Name Registration Fee $70.00 Cdn
Annual E-Mail @ your domain .com $100.00
Payment Type VISA Mastercard
*Required* Card # *Required* Exp. Date
*Required* Name on Credit Card
This form constitutes an agreement between the Domain name holder and Shopalberta to park a domain on Shop alberta's equipment.  All Domains are subject to the policies located at . All graphics must be clothed, no pornographic sites are allowed. This registration does not include webspace for hosting this domain If domain hosting services are purchased from Shopalberta, hosing fees will apply. The registration fee applies to all domains.
Authorization (Signature) You must Type I Agree In Space Provided. All Prices subject to G.S.T.

All applications will be verified prior to any work being completed.