ORDER FORM -
6 Months or 1 Year Web Site Hosting Service Orders must be PAID
WITHIN 7 days or service will be terminated.
E-Mail Address:
First Name:
Surname:
Business Name (if applicable):
Address:
Suburb/City:
Postcode/Zip:
Country:
Web Site Hosting6 Months Hosting
AU$39 (incl GST) (value in Australian Dollars) Web Site Hosting1 Year Hosting
AU$66 (incl GST) (value in Australian Dollars)
YES, please accept my application for your Web Site Hosting service.
Following is my application and payment details:
User Name (name of your web site if already created:
IMPORTANT:
Credit
card orders can also be faxed through on (02) 4577 6942 International
fax number 0011 61 2 45 776942
Send
to: AAA
Media Network, PO Box 5518, Dept WSH, South Windsor, NSW 2756 Australia. Only
cheques which can be drawn in Australia will be accepted. International
Bank Drafts are acceptable from overseas subscribers.
How
would you like to pay? Choose any one of the following:
A Tax Invoice/Receipt
will be issued for taxation purposes.
Credit
card: Mastercard Visa
Bank Card (Australia only)
Cheque: Cheque (please mail this form in with your Cheque).
Service
Required: 6 Months Web Site Hosting
AU$39 1 Year Web Site Hosting
AU$66