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Hosting Sign-up Form
Whats the name of your business?
Put the name of your business in the field. (*)
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Customer Number
Put your customer number in the field. If you have a connect customer number.
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Name of the contact person
Put the name of your IT person in the field. (*)
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Title / Position of the Contact person
Put the position of your contact person in the field.
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Email address
Put your email address in the field. (*)
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Billing address
Put the address where you want the bill sent in the field. (*)
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Phone number
Put your phone number in the field. (*)
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Fax number
Put your fax number in the field.
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Domain Name
Put your website address in the field below. If you do not have this, please let us know.
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Please select your hosting plan
Choose 1 of the following plans (*)

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Programming language/Database required?
(If you have developed your site in any specialised language apart from HTML and have a database, please state that in the field.)
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Additional Requirements
(Please write down any additional comments in the field.)
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Would you like us to develop a place holder site for you?
Please note, this will cost you $60 (once off). You will need to send us the following 1. A logo 2. Preferred color scheme 3. Your business card 4. Contact details) (*)

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