Reseller Hosting Order

Please complete this single page order form to order your Netports reseller service.

1. Your Details:
Your Name:
Your Email Address:
Business Name (if applicable):
ABN (if applicable):
Land Line Phone:
Name of Land Line Phone Listed Under:
Mobile Phone (if applicable):
Street Address:
Suburb:
Postcode:	State:

2. Choose Service:
Select Service:	Choose Service ... BUDGET RESELLER:  - Budget-1 @ $38.50 incl GST Monthly  - Budget-2 @ $55.00 incl GST Monthly  - Budget-3 @ $77.00 incl GST Monthly ---------------------------------------------------- ***RESELLER SPECIALS***  - AP-1 @ $93.50 incl GST Monthly  - Budget-3 @ $58.30 incl GST Monthly ---------------------------------------------------- ADVANCED PREMIUM RESELLER:  - AP-Lite @ $88.00 incl GST Monthly  - AP-1 @ $121.00 incl GST Monthly  - AP-2 @ $143.00 incl GST Monthly  - AP-3 @ $165.00 incl GST Monthly ---------------------------------------------------- BUDGET = Netports Budget Reseller Service FAILOVER = Netports Failover Reseller Service

3. Your Domain Name:
Main Domain Name:	NOTE: If you have not registerd a domain name please do so now at: Register Domain Name

4. Confirm Requirements:
Agree to Acceptable Usage Policy	YES [View Acceptable Usage Policy]
Agree to Terms Of Service	YES [View Terms Of Service]

5. Australian Website Content:
Australian Website Content::	YES NOTE: Netports supplies Reseller services on the condition you will be hosting predominently Australian content websites.

6. Extra Information:
Extra Information or Requirements::

7. Send Order - Make Payment:
Send Now:
	To our secure e-Path gateway to make payment