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Download printable version - Web Hosting Application form

Web Hosting Application Form
Web Hosting Application Form
PO Box 20 Chadstone 3148 Phone: 03 9885 4655

 Contact Information

Company:
Address:
Suburb:Postcode:
Phone:Fax:Mobile:
Email:Licence No:

 Do you already have a registered Domain Name?

If Yes Please Enter Domain Name

 Web Hosting Package

BasicStandardBusinessProEnterprise
Email Accounts101002004001000
Capacity50 MB2 GB10 GB20 GB100 GB
FTP Accounts125101000
Databases015101000
Sub Domains05601001000
Add-on Domains001020100
Parked/Stacked Domains00unlimitedunlimitedunlimited
Traffic2 GB20 GB50 GB100 GB500 GB
PHP (v5.2.17)yesyesyesyesyes
Webalizer Statisticsyesyesyesyesyes
SSH Accessnononoyesyes
Web Based File Manageryesyesyesyesyes
Cronyesyesyesyesyes
Custom Digital Certificateyesyesyesyesyes
Anonymous FTPyesyesyesyesyes
CGIyesyesyesyesyes
SSL Certificatesyesyesyesyesyes
Web Control Panelyesyesyesyesyes
Webmail Accessyesyesyesyesyes
Wordpress, Drupal, Joomla capablenoyesyesyesyes
Cost per month$ 8$ 15$ 25$ 40$ 200
   Notes:
  • All prices are including GST.

 Credit Card Direct Debit Authorisation

 VISA MasterCard American Express Other
Card Number:
Expiry:/
Card Holder's Name:

 Agreement

I agree that the above details are true and correct. For credit card payment, I understand that my credit card will be debited for all set-up charges and monthly in advance for the access fee. Once connected, I agree to abide by the terms and conditions found at agreement or available on hardcopy upon request. This form must be signed if submitting by hardcopy. The signatory must be at least 18 years of age.
Please verify by clicking the "I am not a robot box" before processing application
 I Agree

Download printable version - Web Hosting Application form