Virtual Hosting Order Form Your order is secure on this SSL
To Order the set-up of one of our Virtual Hosting packages, please fill
in this confidential form
If you need advice before procceeding, let us know here
Standing Order (Yearly)
If you chose to pay by credit card, the system will authorize the
card for the amount due. This is an authorization only, and
NO CHARGE will be applied to your account at this time.
We will require confirmation by fax.
Credit card number
Expiry date of the card
Name on the Card
CC Billing Address
Domain Name ( We will
check the name manually and advise you of the availability)
Hosting plan you require
Would you like Fnont Page
Extensions installed ?
Please Enter an e-mail address
thet you would like to have for this domain.
You will be able to add more as
soon as your account has been set up.
Enter the Name you want to appear
in the 'sent by' field for this e-mail account. (Real Name)
Enter your prefered password in
Please enter any special
instructions for this account in the box provided.
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Thank you for your valued custom. We look forward
to hosting your site