$0 Base Price
+ $NaN Registrant
+ $NaN Last Name
+ $NaN First Name
+ $NaN Date of Birth (Format must be MM/DD/YYYY)
+ $NaN Address Type (e.g. office, home)
+ $NaN Address
+ $NaN City
+ $NaN State/ Province
+ $NaN Country
+ $NaN Zip / Postal
+ $NaN Telephone Type (office / cell)
+ $NaN Area Code (e.g. 780)
+ $NaN Phone Number (e.g. 7281968)
+ $NaN Email
+ $0 Price Modifiers
$0 Subtotal