Fields marked with a * are required.

* First Name :
* Last Name :
Company / Organization :
* Street Address 1 :
Street Address 2 :
* City :
* Province / State :
* Country :
* Postal Code / Zip :
* Phone Number :
Fax :
* Email Address :

Enter the Domain Name you will be transferring.

* Domain Name :

(no spaces)

$ 20 We will extend your existing registration for an additional year.

Prices are in Canadian dollars.
Please note that GST only applies to residents of Canada.

Billing Address ( if different from address above ) I will be making payments by: Cheque Visa Mastercard Your security is our #1 priority. Due to security reasons, if paying by credit card, we will have one of our customer service representatives contact you for your credit card information. Please note that charges will appear on your credit card from "IT Life". If paying by cheque please make cheques payable to "IT Life". Please note that we can not process your application until the cheque arrives and has cleared. If you require assistance in filling out any part of the above form, please feel free to contact us.