DOMAIN OWNER/CLIENT INFORMATION

Registered Company Name:


Trading Company Name:


Company Registration Number:


Full Name/s & ID Number/s of Director/s:


VAT Registration No.:


Telephone No.:


Fax No.:


Physical Address & Code:


Postal Address & Code:


Accounts Contact Person Name:


Email Address for Invoicing:

DOMAIN INFORMATION

I hereby authorize Tristar Technologies to register/transfer the below mentioned domain(s) to the DNS servers of Tristar Technologies:

Domain Name/s:


Current hosting provider (if applicable):

MAILBOXES CURRENTLY IN USE & NEW MAILBOXES REQUIRED ON THIS DOMAIN

AUTHORITATIVE DOMAIN CONTACTS

First Authoritative Domain Contact

(Person who is signing this contract & may request changes/credentials/support on the domain):

Name:


Email Address:


Cell No.:

Second Authoritative Domain Contact

(Person or website development company who is authorised to request changes/credentials/support on the domain):

Name:


Email Address:


Cell No.:

DEBIT ORDER AUTHORISATION FORM

PERSONAL DETAILS OF CLIENT

Surname / Company Name:


Full names / Trading Name:


ID number / Registration Number:


Physical Address:


Postal Address:


Email Address:


Contact details and cell number for SMS notification:

Work Phone:


Mobile Phone:


Fax:

Client Reference Number:

BANK DETAILS OF CLIENT

Name of Account Holder:


Account Type:
CHEQUETRANSMISSIONSAVINGSOTHER

Name of Bank:


Account Number:


Branch Name:


Branch Code:

COLLECTION INSTRUCTION

Monthly Deductions:
Yes

Date of 1st Deduction:


Monthly Fee incl VAT:

Please choose one of the following options:

1) Please deduct my account with the full outstanding amount as at the 20th of the previous month plus my monthly fee
1) Please deduct my account with the full outstanding amount as at the 20th of the previous month plus my monthly fee


2) Please deduct my account with the set monthly fee and I will pay any additional outstanding balance via EFT
2) Please deduct my account with the set monthly fee and I will pay any additional outstanding balance via EFT

I authorize the debit order as per the terms and conditions.

DECLARATION

Full Name:


Position/Designation:


Signature:


Date:

HOSTING PACKAGE FEATURES

Disk Space:


Traffic:


Mailboxes:


Email Aliases:


FTP & MySQL Support:
YesNo

Online Control Panel:
Yes

Webmail Access:
Yes

Daily Server Backups:
Yes

DETAILED COSTS

New Domain Registration .co.za:


Annual Domain Renewal .co.za:


Monthly Hosting Services:

TERMS & CONDITIONS

I have read and agree to the Terms & Conditions.