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Web Hosting Order Form

You are ordering simplePlus at the cost of $359.00

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Contact Details

First Name *
Last Name *

Company Name (if applicable)
Email *
Important: Your account details will be emailed to this address

Address 1 *
Address 2
City/Town *
Zip/Post Code
State/Provence
Country *
Phone
   

Account Details

Domain Name (to be hosted) *

Payment Method

Direct Credit - Yearly Payments Only (available only within New Zealand):
Select this method if you would like to transfer funds electronically directly into the Simple Hosting account. Your account will be activated within 24 to 48 hours of confirmation of payment.

Invoice/Cheque - Yearly Payments Only (available only within New Zealand):
If you choose this method of payment, you will be invoiced for the hosting services via email. Your account will be activated within 24 to 48 hours of confirmation of payment.


Please select the method of payment you have chosen
Subscription Cycle *

Please provide a brief description of your website.

If you have been referred by an existing customer please enter their domain name & name in this comments area so they may receive their referral entitlements.



Please choose the most appropriate I am building my website now.
I have already built my website and I am ready to upload it.
I am transferring an existing site from another host.

  I agree to the terms and conditions.
 
 

 

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