Secure credit card remittance form

Important!! If your desired transaction requires a specific form to accomplish what you want with CIRA (eg: new domain or TBR application, renewal, or Registrar transfer), use your web-browser's "BACK" button and complete and submit *that* form on the secure server instead if you've not already done so.

Select Credit Card Type: (VISA or MasterCard)
Please apply my payment to my:

for the .CA domain: .CA
Careful! Do NOT prepend the name of any host (such as "www")

Complete the following EXACTLY as they appear on your credit card:
credit card number
credit card-holder name
/ credit card expiry date
Amount to charge to credit card: $

How to contact me - the person completing this form:
My Name
My Organization
My Areacode & Phone#
->IMPORTANT: provide an email address that works! My Email Address

By clicking on , I hereby certify that I am the person named above, and authorize the fees to be charged to the credit card specified.

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