Application Form for Hosting Services

Section 1.

Particulars of Registrant:

1. Fullname:
- Dr/Mr/Mrs/Mdm/Ms*
- First Name: 
- Last Name:

2. Company/Org. Name:
(Leave blank if you are applying as an individual.)

3. Company/Business/Org. Registration No.:
(Leave blank if you are applying as an individual.)

4. Address:

5. City:

6. State:

7. Country:

8. Postal Code:

9. Telephone:

10. Fascimile:

11. Pager/HP: 

12. Email:

-=-

Particulars of Admin Contact:

1. Fullname:
- Dr/Mr/Mrs/Mdm/Ms*
- First Name: 
- Last Name:

2. Company/Org. Name:
(Leave blank if you are applying as an individual.)

3. Company/Business/Org. Registration No.:
(Leave blank if you are applying as an individual.)

4. Address:

5. City:

6. State:

7. Country:

8. Postal Code:

9. Telephone:

10. Fascimile:

11. Pager/HP: 

12. Email:

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Section 2.

Hosting Plan:
(Setup Fee waived for all hosting plans)

1. Domain Only
2. W100 (Win 2K3), 100MB, 10 POP3 Email Accounts, Unmetered MDT, S$144.00 /yr, S$259.20 /2yrs
3. W300 (Win 2K3), 300MB, 30 POP3 Email Accounts, Unmetered MDT, S$360.00 /yr, S$648.00 /2yrs
4. W600 (Win 2K3), 600MB, 60 POP3 Email Accounts, Unmetered MDT, S$600.00 /yr, S$1,080.00 /2yrs
5. C200 (Linux), 200MB, Unlimited POP3 Email Accounts, 10GB MDT, S$96.00 /yr, S$172.80 /2yrs
6. C500 (Linux), 500MB, Unlimited POP3 Email Accounts, 20GB MDT, S$192.00 /yr, S$345.60 /2yrs
(Please add 7% GST for Singapore-Based Customers)
(MDT - Monthly Data Transfer)

Enable FrontPage Server Extensions: Yes / No*

Term: 1 Year / 2 Years*

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Section 3.

Domain Name (e.g. domain.com):

1. I want to register the new domain with Axac Solutions. (Skip Section 4)
2. I will register the new domain myself elsewhere. (Skip Section 4)
3. I already own a domain. I will transfer the DNS myself. (Skip Section 4)
4. I already own a domain. Please help me transfer the DNS. (See Section 4)
5. I want to transfer my domain registrar to Axac Solutions. (Skip Section 4)

NRIC/Permanent Resident No. (for .sg / .per.sg only):

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Section 4.

If you have already registered a domain with a Domain Registrar, and you would like Axac Solutions to point your DNS to Axac Solutions' DNS server, then fill in this section.

1. Domain Registrar:
(Enter the Name of the Domain Registrar where you have registered your domain.)

2. Registrar's Login Page:
(Enter the URL of the Domain Registrar where you can login to manage your domain.)

3. Account Details:
- User ID:
- Password:

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Section 5.

Remarks:


NOTE: * Delete where appropriate.

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Please send this form to sales@axac.com or mail it to our office as given below. By submitting the application form, you agree to accept and be bound by the Terms and Conditions as displayed on our web site. Do note that your order will only be processed after payment is made.

Payment can be in the form of cheque, money order or bank draft made payable to "Axac Solutions Pte Ltd". Please include your domain and contact number overleaf.

You may also make payment to the following POSB Savings Account:

Account No. 017-18139-4
Account Type. POSB Savings Acct

Or to UOB Current Account:

Bank Code: 7375
Branch Code: 059
Account No. 926-343-380-3
Account Type. UOB Current Acct

Please inform us if the payment is made via Interbank Fund Transfer. Include the date, time of transfer and to which account the money is transferred.

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Axac Solutions Pte Ltd
50 Bukit Batok Street 23
#07-14 Midview Building
Singapore 659758

Tel: +65-68962180
Fax: +65-65696891