PO Box 20

Remote Backup Application Form

 Chadstone  3148
Phone:  03 9885 4655

 Contact Information

Company:
Address:
Suburb: Postcode:
Phone: Fax: Mobile:
Email:

 Site Information

   Address:
Suburb: Postcode:
Phone: User: Password:
IP Addr: . . .

 Backup Plans

Storage Monthly
Anytime backup plans:
10GB $18.00
25GB $30.00
50GB $45.00
100GB $70.00
150GB $90.00
200GB $110.00
500GB $235.00
Nightly Automated Server Backup:
500GB $100
1TB $190
2TB $370
   Notes:
  • All prices include GST.
  • Two computers or servers per account.
  • Nightly backup to commence after 7pm.
  • A fixed IP is required for this service.

 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 monthly in advance for the access fee. This form must be signed if submitting by hardcopy. The signatory must be at least 18 years of age.
 I Agree
              Name                             Position                             Signature                       Date