Virtual Hosting Order Form
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To Order the set-up of one of our Virtual Hosting packages, please fill in this confidential form
If you need advice before procceeding, let us know here

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              Please provide the following contact information:
First name
Last name
Title
Organisation
Street address
Address (cont.)
City
Province
/Postal code
Country
Phone
FAX
E-mail
URL

Payment Method

Visa
Mastercard
Cheque
Standing Order (Yearly)
Cash
If you chose to pay by credit card, the system will authorize the
card for the amount due. This is an authorization only, and
NO CHARGE will be applied to your account at this time.
We will require confirmation by fax.

Credit card number


          Expiry date of the card

          Name on the Card

          CC Billing Address
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
          Domain Name   ( We will check the name manually and advise you of the availability)

          Domain Type
New Domain
Transfer an existing domain

          Hosting plan you require

          Would you like Fnont Page Extensions installed ?
Yes No
          Please Enter an e-mail address thet you would like to have for this domain.
          You will be able to add more as soon as your account has been set up.

          Enter the Name you want to appear in the 'sent by' field for this e-mail account. (Real Name)

          Enter your prefered password in this box

          Please enter any special instructions for this account in the box provided.

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Thank you for your valued custom. We look forward to hosting your site netche1.jpg (7221 bytes)

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Copyright Armata 1998 -2006
Last revised: November 22, 2006