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New Account Order Form.

Required =

Domain Name: 
NIC Handle: 

If you don't know what a NIC Handle is, then you won't need to fill this in.

 
Contact Person: 
Title / Position: 
Your Trading Name: 
Postal Address: 
Town, City: 
State:    Postcode:
Phone: 
Fax: 
Primary e-mail: 
Secondary e-mails:  Separated by comma (,)
Purchase Order Number:  If Applicable

Madog Media Hosting Package PopUpPage

Bare Bones package. ($50.00)  

Snow Gum package. ($75.00)

Blue Gum package. ($100.00)

Red Gum package. ($150.00)

Extras: 

extra e-mail addresses.

Extra Mb of web space required.

Other Extras.

If other, please specify:

e-mail Configuration: 

A default primary e-mail address needs to be set up.

Usually something like info@ or sales@yourdomain.com.au

What would you like yours to be ?

@yourdomain.com.au

Have e-mail held for collection at the ABOVE address.

Have all e-mail received at this address and Redirected

       to my current e-mail address of:

Comments or Questions: 
 

 

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