Pixelsound Web Design Perth :: Web Hosting Order Form

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Hosting Order Form

* Title:

* Title:Ms
Mrs
Mr

* Your Name:

Company:

* Email:

* Phone:

Mobile:

Hosting Account

* Hosting Package

* Hosting PackageBasic ($19.80 p/month)
Basic Plus ($27.50 p/month)
Advanced ($44.00 p/month)
I don't know

* Website domain names:

I need databases:

MySQL

PostgreSQL

I don't know

I need PHP:

* PHP

* PHPNo
PHP5 (default)
PHP4
I don't know

I need secure pages (SSL)

* Secure Pages (SSL)

* Secure Pages (SSL)Yes
No

My website features the following applications:

Mailform (CGI)

Online Shopping Cart

Content Management System

Guestbook

Forum

Mailman mailing list

other mailing list

Online Chat

Please specify:

Email

Email Protocol

Email ProtocolI don't know
POP3
IMAP
I host email with...

Email hosted with:

Email forwarded to...

Billing Details

* Company:

* Address:

* Suburb:

* State:

* Postcode:

Country (if other than Australia):

Pixelsound Web Design Perth

Innovation. Service. Usability.

Web Hosting Order Form

Hosting Order Form