NZHost.Com: Order Form

Internet presence order form

Great! So you'd like to get your Internet presence up and going (or save money with your existing one)
To do so, simply fill in this form completely then click the "Send Order" button at the bottom.
Alternatively, you can fill out the form, then print it out and fax to (09) 443 2977 from inside New Zealand, 64 9 443 2977 from anywhere else, or post to P O Box 47-327, Ponsonby, Auckland, New Zealand.
After each entry, use the TAB key or your mouse to go to the next entry area. We assume that you have already read the standard terms and conditions.
If not, please click on this link now, then return once you have printed them out and read them

Please create a NZHost.Com Website for us as specified below

Name:

Company: (Owner of domain name)

Address:

City/ Town Country

Ph (bus.) Ph (home)

Fax: Mobile:

E-Mail:

The plan we want is:

Domain Name required:

We already have the domain name entered below
We don't currently have a domain name, and want the following one:
I'm not sure what we want - please call with suggestions

(NOTE: Please make sure you include your suffix - "yourname.co.nz" for a New Zealand domain name, "yourname.com" for an international one if you wish to appear more international).
If you are ordering a new domain name, make sure you have entered in the "Company" field above the legal entity that will own the domain - your company name if a company, your name if a sole trader

Select Credit Card: Amex Bankcard Mastercard Visa

Card Number Name:

Expiry Date

NOTES:

Any credit card details you give will be used for security only for this first payment so that we can get things underway immediately, and will not be debited to your card unless you default on your payment after we invoice you for your first payment & setup, which you pay in your normal fashion.
We further undertake that we will not take any future payments from this card without your authority. Unless you give us permission when we contact you we will not keep any record of this number and undertake that we will never use it again in future.

If you aren't happy about sending credit card details over the Internet, continue filling in this form but don't click on "Send Order" - just print it out and fax to (09) 443 2977

If you're not happy about giving your credit card details to us at all (or don't have one that's suitable to use), simply leave this section blank and we'll contact you re payment by cheque or automatic payment. However, bear in mind that in this case we cannot get things underway until we receive your payment.
If you don't want to wait till then, but want to get your account and site under way as soon as possible, then include a cheque for your first months or years payment (at the lower rate for "payment by A.P".) with this form and post to P.O. Box 47-327, Ponsonby, Auckland. Don't forget to add the amount for the account setup to this ($49 for an Entry Level account, $68 for a Basic Domain, $98 for a Full Domain & $138 for a Full Domain Pro).

Any other comments or questions?:

This order assumes that you have read and agree with our standard terms and conditions
If you have not yet read these terms, then please click here now to peruse them
Once you have read the terms and conditions then type the word "ACCEPT" in the following box, then click on the "Send Order Now" button to send your order, or else you may print the form now and fax to (09) 443 2977 from inside New Zealand, 64 9 443 2977 from anywhere else.
Type "ACCEPT" in the box:

Return to Home page