Secure eHost - Hosting Application

Account Holder Details

Contact Name

Contact Email

Postal Address

Billing Address

Business / Org Name
(if applicable)

ABN (if applicable)

Telephone

Domain Name Details

Note: you can register a new domain name at netregistry.com.au

Domain Options	Register a new domain - $88 for 2 year license. Use an existing domain name that I have already registered.
Domain Name

Hosting Packages

Please refer to our Hosting Packages & Prices (PDF) document for pricing & hosting package details.

Hosting Package

Email Account Details

Do you wish to host your mail with us?

No

Yes

Payment Method

Upon receipt of your application, Secure eHost will email you a tax invoice for you to process your payment before we setup your account. To speed up this process, if we receive a bank receipt on payment then we can can setup your hosting account quicker.
Please tick which payment option you will be using to pay your account.

Direct deposit to our bank account (Preferred method)

Posted cheque

Terms and Conditons - Service Level Agreement

By lodging this Application you confirm that you have read, understood, agree with and will conform to the Hosting Terms and Conditions (PDF) which are a separate document and form part of this Application. We recommend that this Application be completed with reference to the current Hosting Packages & Prices (PDF) document which details all services included.

Hosting Terms and Conditions (PDF)
Hosting Packages & Prices (PDF)

If you have trouble viewing or downloading the hosting T&C and pricing PDF's, please email queries@ehost.com.au

Yes I Agree with the Terms & Conditions

Additional Comments

Registrar Details
Registrar Company	I.E. The registrar company that you registered the domain name with E.G. Netregistry
Registry Key	When you register a domain you may get a registry key number (can be alpha numeric)
Registrar Login Details
Username
Password

Hosting Account Application