Sricom Net Services - Account Application

ACCOUNT APPLICATION

Sign up now! Fill in this form to order your Web hosting service today and establish your Internet presence. We will have your new virtual server up shortly after payment is finalised. You will also be given access to the restricted section where you'll be able to make changes to your account.
New Client Information
Personal Details.
First name*	Last name*

eMail Address	Business name


How did you find this site?
Domain Name of Referrer

Terms and conditions read and agreed*	Yes No

Subscription Options.
S250 Premium
S100 Standard Plus
S50 Standard
S25 Basic
S5 Micro

Mailing & Contact Information.
Street Address (1)*	Street Adress (2)

Suburb/City*	State

Zip/Postal Code*	Country

Phone number*	Preferred times for us to phone

Fax number (if applicable)	Time Zone


Domain Name Registration.

Create a new domain name	Move existing domain

Domain name (1st Choice)	Existing domain name

Domain name (2nd Choice)


Payment Information.
We will contact you to arrange for your payment. If paying in Australian dollars through BPAY, your initial payment will be for 12 months. If in US dollars, you may pay monthly. Our first response will be by e-mail unless you indicate specifically that you wish to be contacted by telephone. If you provide an unusable e-mail address, we will be unable to process your application. We will usually be in touch by telephone or e-mail within 15 hours of your application being received (please allow a little longer for public holidays and weekends). Please ask any questions or add special notes: