Web Hosting Order Form

To order our standard hosting package at $NZ25 per month (approx $US16) please complete these details. You have the option of paying on invoice (New Zealand only, by cheque or internet banking) or by credit card.

A * symbol appears beside required fields

FIRST NAME*

SURNAME*

EMAIL*

BUSINESS NAME

POSTAL ADDRESS 1*

POSTAL ADDRESS 2*

CITY/TOWN*

COUNTRY*

PHONE*

Do you already have a domain name to use on this account?
Do you

INTEREST(S)

Web Design
Hosting

OTHER QUESTIONS OR COMMENTS