Domain Hosting 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:	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: