After I get all the info typed and click"submit" I get a panel asking what I think is a request for my password and a "domain" Its not working ,what am I supposed to be putting in the boxes?

 

I tried to duplicate it and can't come up with it.

If you put up some more details about the option you choose in "step two" and any other options you select in step three I might be able to help, and in the meantime will point some people toward this.