Wholesale Microsoft Windows Website Hosting – Discount Domains Application

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ConcordNet Australia - WINDOWS Wholesale Website Hosting Application Form

Why pick a plan that is not right for you. Simply design your own plan and ConcordNet will quote you on how much it will cost. Usually completed in less than 5 minutes, our easy-to-use ordering wizard will help you through the process of gathering the information we need to give you a quote for your own self structured hosting account.

Choose the items that best suit you below: If you have special requirements please email us. Please Note: * - Required Fields

1. Qualification for Wholesale Pricing:

Please tick the box(es) of the organisations that you are a part of or affiliated with to receive your wholesale website hosting and domain name registration:*

	Existing ConcordNet Customers		Members of Chambers of Commerce
	Website Owners Transferring Their Hosting to ConcordNet		Members of Gifts & Homewares Australia
	Registered Charities and Non Profit Organisations		Members of the Australian Chamber of Manufacturers & Affiliates
	Accredited Web Developers		Members of the Australia Retailers Traders Association & Affiliates
	Members of Leading Edge Buyers Group		Members of the Real Estate Institute & Affiliates
	Members of the Eros Foundation

2. Domain Set-up:

Would you like to transfer your an existing domain from another hosting provider or register a new domain?

What is the domain name:

. *

If you are registering a new Domain, please choose your price:

3. Website Hosting Set-up

Please choose the Hosting Account that you would like to purchase from the drop down list on the right: *

4. Databases, PHP, ASP & Cold Fusion

Do you require an MS SQL Database:*

Yes No

Database Name:

Do you require PHP: (Not included in Starter Plan)*

Yes No

Do you require an MS Access Database:*

Yes No

Database Name:

Do you require ASP:*

Yes No

Do you require Cold Fusion:*

Yes No

5. Contact Information

Contact Person: (person to contact within the business)

Organisation: (if Applicable)

Phone:

Fax: (Optional)

Mobile: (Optional)

Street Address:

City:

State:

Post Code

Do you have an existing Email Address:

6. Payment Details

Please Note: if you choose Cheque, your account will be processed only when your payment clears)

Payment Type:

Credit Card:

Card Number:

Cardholder Name:

Expiration Date:

Security Code: What is the Security Code?

Additional Information (that we should be aware of)

How Did You Find ConcordNet? * If other, Please specify who or where

I agree to the ConcordNet's Terms & Conditions. Click left to read. (You must accept the conditions to proceed)