DEDICATED HOSTING PTY LTD - Co-location Order Form

for your customised solutions

sales@dedicatedhosting.com.au

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Dedicated Hosting Secure Order Form

Please fill out the form below and a representative will contact you and provide you with confirmation of your order and a pre-completed Service Order Form and Services Agreement.

You chosen service type

If you want to find out more information on any service, please select a service from the combo-box and click the 'More Details' button.

more details / price list

Optional add-on

• Telephone Support
• Extra IP Address
• Remote Reboot

Contact details

• Client ID
• Client Password
The rest of the information in this section only needs to be filled out if you do not have a Client ID!
• Title
• First Name*
• Last Name*
• Position
• Orginasation
• Address*
• City, State, Postcode*
• Country:
• Phone Number*
• Fax Number
• Mobile
• E-Mail

Billing Details

• Card Type
• Name on Card
• Card Number
• Expire Date

Comments

How did you find us? (E.g Yellow Pages, Anzwers, Associate etc...)

All prices listed above include 10% GST. By clicking on the button below, you agree:

• to ablide by the Dedicated Server Agreement visible at http://www.dedicatedhosting.com.au/legal/dsa.pdf.

• Agree to pay all fees due, including excess bandwidth and extra services requested at time of invoice.

• Authorise Dedicated Hosting to debit any fee due from my credit card at time invoice.

Enquiry : sales@dedicatedhosting.com.au

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