Online Domain Registration or Domain transfer application form

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Online Application to register Domain, or to process Domain ownership transfer from existing hosting account.
This is also your application to have the Website Designed (If Applicable) and Hosted in terms of Website hosting agreement by
Personal Details:

Registrant First Name and Surname:


ID Number:

Postal Address and City or Town:

Postal Code:

Your Company or Business Information:

(If you do not have a Company or Business just type not applicable in each block to complete the form)

Company, School, Church, Charity or name:

Street Address:

P O Box:

City or Town:

Postal Code:

(If you do not have a Company or Business just type not applicable in each block to complete the form)

Contact Details:

Work Number and Dialing Code:

Home Number and Dialing Code:

Fax Number and Dialing Code:

Cell Number:

Domain and Website Hosting Package Information:

Domain Name: Example or .com etc.

Select Website Hosting Option: Example Basic Hosting or Standard Hosting etc.

Select Website Designing Option: Example 5 Page with 10 Pictures or 10 Page with 20 pictures

Request's assistance to transfer the existing Domain/Website to Please select Yes or No

To Apply for our Website builder software with your account select Yes or No

Please note that we can not be held responsible if you make a mistake in the spelling of the domain name you select. Please check domain name before submitting the form. You will be liable for a full domain registration fee in the event of you wanting to change the name of a domain after submitting this form.

When you complete and submit this form you confirm and agree that you are

 authorised in your capacity  as the Owner or Delegated person of the Business 

you are working for to place this order or as a private person.

I have read and agree with the terms and conditions of service.
 To read the terms and conditions.

or you can print this form,

complete it and please sign it at the space below and post or fax it to us:

85 Berg Street Standerton, 2430

FAX 086 662 2662



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