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Verisign Certificate Request Form
GENERAL INFORMATION
Common Name:
The server's fully qualified domain name. (It must be registered to the organization specified in that field), in the format: www.company.com (secure.company.net, company.com, org.edu, and so on). It's the URL used to access the pages that will be protected with the certificate.
Organization/Company:
The legal name under which your organization is registered. DO NOT abbreviate.
Organizational Unit:
This is used to differentiate between organizational divisions. Also for Doing Business As names. DO NOT abbreviate.
City/Locality:
Required for organization registered only at the local level. DO NOT abbreviate.
State/Province:
The complete name of the state or province where your organization is located.
Country:
The two-character ISO-format country code. For example, GB for Great Britain and US for the United States.
Webmaster Full Name:
Webmaster E-Mail:
Webmaster Phone:
D-U-N-S Number:
If you have a Dunn & Bradstreet D-U-N-S Number registered for your organization, it may expedite the verification process and issuance of your Secure Server ID.
CONTACT INFORMATION
Organizational Contact
Last Name:
First Name:
Title:
Company:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Daytime Phone:
Fax:
E-Mail Address:
Technical Contact
Last Name:
First Name:
Title:
Company:
Address:
City:
State/Province:
Zip/Postal Code:
Daytime Phone:
Fax:
E-Mail Address:
Billing Contact
Last Name:
First Name:
Title:
Company:
Address:
City:
State/Province:
Zip/Postal Code:
Daytime Phone:
Fax:
E-Mail Address:
(This cannont be a free e-mail address, such as yahoo.com, hotmail.com, or aol.com)
Technical Contact
is the person who should receive the certificate and who will provide notice if the Digital ID is compromised. (For example, this may be your organization's webmaster or the appropriate technical support representative at your ISP (Internet Service Provider)). Renewal notices are sent to both the technical and organizational contacts.
Organization Contact
is the person within your organization who will take responsibility for the certificate and provide organizational information. (For example, this may be your organization's CEO or the appropriate support person. The organizational contact must be a member of your organization, not a representative of your Internet Service Provider.) Renewal notices are sent to both the technical and organizational contacts.
CERTIFICATE REQUIREMENTS
Type of Certificate:
40 bit
128 bit
Please select all that apply:
Cert with managed PKI
Cert with Commerce Site Services (Online Payment Services)
Certificate Validity Period:
1 year
2 years
Number of Licenses:
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