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Website Hosting & Domain Name Application Form
     I agree that I am a new client and request that Bizness Connect.Com set up a new account for the following services
     I agree that I wish to transfer from my current service provider to Bizness Connect.Com for the following services
Hosting Services
Domain Name Hosting Services
Both Hosting & Domain Name Services
Section One :
 Client Details
Company Name:
Contact Name:
Contact Email Address:
Website Address:
Section Two:
 Requested Hosting Package
Please select the hosting package you would like us to setup
cPanel 50 
cPanel 100
cPanel 200
cPanel 300
cPanel 400
cPanel 500
Section Three :
 Purchase Domain Name/Transfer Domain Name
Please enter the domain name you would like us to purchase on your behalf or if you are transferring your domain name to be hosted by us please write down your current domain name UDAI Code.
Domain Name:
 www.
  (You will be required to sign a domain name agreement before it is purchased) 
UDAI Code:
  (Unique domain authentication identification)
Section Four:
 Transfer Details
This only relates to you if you are transferring from your existing service provider to Bizness Connect.Com
Please only tick what relates to you, if you have any questions please call us
Bizness Connect will complete the hosting Transfer The Client will complete the hosting Transfer themselves
Bizness Connect will complete the Domain Name Transfer The Client will complete the Domain Name Transfer themselves
Bizness Connect will complete the Domain Name Server Setup The Client will complete the Domain Name Server Setup themselves
Bizness Connect will Setup the first initial email The Client will Setup their emails themselves
Section Five:
 Authorisation

I agree that all information is true and correct, I agree to the Terms and Conditions as set out on the Bizness connect website and I give authorisation for Bizness Connect to proceed with my application as outlined above. Please Select

   
 
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