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Web Hosting Signup Form

   
1. Login name *
 (Create a user name for domain and web hosting control panels)
2. Password *
   
3. First Name *
4. Last Name *
5. Organization Name
6. Street Address *
7. Street Address Line 2
8. City *
9. Province / State *
10. Postal / Zip Code *
11. Country *
12. Phone Number *  (eg. +1.4165551122x1234)
13. Alternate Phone Number  (eg. +1.4165551122x1234)
14. Fax Number
15. Email Address *
16. Alternate Email Address
17. Domain Name * www.
18. Domain name already registered?
Yes  
No    (Please ensure the domain is available. Click here to check availability)
 
19 to 23 only required for .ca domains
19. Is this domain a registered trade-mark?
Yes
No
20. Would you like to become a CIRA member?
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21. Legal Type
   
22. Package Required
Basic Plan $83.88 ($6.99/month) CDN (includes free domain)
Standard Plan $119.88 ($9.99/month) CDN (includes free domain)
Advanced Plan $179.88 ($14.99/month) CDN (includes free domain)
23. How did you hear about us ? *
 
24. Please read and accept the following agreements before signing up (new pages will be opened). *
I agree to iQWeb Web Hosting and Domain Registration Terms of Service
   
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