| Title |
|
I, the undersigned have read and understood the terms and conditions of this application and the information that I have supplied in this subscription form is, to my knowledge, true and correct in every respect. Payment by direct debit |
| I Account type: |
|
I,
hereby give authorisation to Interexcel to withdraw from my account / my company's account, detailed above, the Domain Name Registration fee in the amount of R
on the first of the next calendar month. |
The following details are required should you be hosting your own site and have your own E-mail server. |
| Primary Network Server Name (Name Server |
|
| Secondary Network Server Name (Name Server): |
|
| Network IP Block (Start) : |
|
| Brief description what the company does |
|
Do not fill in this input field: