Extraordinaire Hosting Packages

Please fill in the form below to order a new service. To order internet access please click here
Your name
Daily contact
e-mail
Would you like to order	A new web site
	Hosting
	Domain registration
If you need hosting, please fill in the details below:
Domain name of your site
Which hosting package do you require
If we must register your domain name, please fill in the details below:
Domain owner name
Owner contact number
Owner fax
Owner postal address
Owner physical address
Banking Details (If you choose to pay by monthly debit order, please fill in details below)
Bank (ABSA, FNB, etc)
Acc name
Acc No
Branch
Branch code
Debit order date?
Must we add domain registration to first debit? (where applicable)
I hereby request, instruct and authorize Extraordinaire Systems to draw against my bank account as recorded above the relevant hosting fees on a monthly basis and to continue until such time as this instruction has been cancelled by virtue of my/our requesting so in writing, giving one month notice of such requests. All withdrawals from my/our account shall be treated as though they have been signed by me/us personally. I understand that such withdrawals shall be processed through ACB Magnetic Tape service and shall be printed on my account statement. I agree to pay the bank charges to this instruction. I understand that my service will be suspended and that a reconnection fee of R150.00 will be charged should my service be cancelled due to non payment. Extraordinaire Systems reserve the right not to render a service to web sites which contain adult or violent information. I have read your terms and condition and agree to it.