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PRECISIUM
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Phone:   +61 2 9966 8228
Fax:   +61 2 9901 3027
Email:   info@precisium.com.au

Application Form

Windows1 hosting & email package

$22.00/Month No setup fee. (AUD includes GST)
Sales Fax:  02 9901 3027
Sales:  02 9966 8228
Email:  sales@webpub.net
Precisium
1 Wisdom Rd
Greenwich NSW 2065

PART 1: SERVICE DETAILS


1a) DOMAIN NAME:

Please indicate the domain name that you would like to use for this hosting & email service.

Your domain name either has to be 'delegated' to our nameservers so we can configure it correctly for email, or you will need to talk to us about pointing MX records to our servers.

It is also possible to use one service provider for email & another for web hosting
You may also have more than one domain name linked to a mailbox.

If there are any special circumstances with your domain name (e.g you'd like us to register and or delegate it for you) , enter a brief note in the comments box at the end of this form.

Domain Name (e.g yourcompany.com)

1b) USERNAMES AND EMAIL BOXES

Usernames are used to retrieve email, and to upload webpages and files to the system. All usernames are prepended with a unique prefix (accountid) identifying your organisation.

Please select an Account ID, preferably about 5 characters long.

 (required)
e.g If your business name was "Logitech" you might choose "logi" or "lgt"

Emails do not have to be redirected to another address. You can send and receive using our mailserver(s) directly, regardless of which ISP you are connected with.
Some ISPs block outgoing email on port 25, but will still allow you to access our systems on the alternative mail submission port: 587

USERNAME

will be prefixed with the accountid to form: "accountid.username"

Password (numbers & letters only, at least 5 characters long) email addresses - Each of the mailboxes may have multiple email addresses
(see Email FAQ)
Sample Mailbox:
Pass:
Addresses:
  Redirect to (optional):
User 1:
Pass 1:
Addresses:
  Redirect to (optional):
User 2:
Pass 2:
Addresses:
  Redirect to (optional):
User 3:
Pass 3:
Addresses:
  Redirect to (optional):
User 4:
Pass 4:
Addresses:
  Redirect to (optional):
User 5:
Pass 5:
Addresses:
  Redirect to (optional):

PART 2: CUSTOMER AND BILLING DETAILS

Individual/Business or Company Name/Organisation Name
Trading Name:
Business Registration Number or ACN:
Australian Business Number (ABN):
Registered Business Address (not a PO Box):
Postal Address:
Invoice Delivery Method:
Hardcopies mailed to your postal address only.
eMailed invoice only, in html format
Both
Billing Frequency:
Monthly.
3 Months in Advance
6 Months in Advance
12 Months in Advance
Billing Contact:
Name:
Phone:
Fax:
eMail:
(Please supply even if not receiving invoices by email)

Administrative Contact:
(use "as above" as necessary)

This contact should generally be the owner of the domain name,
and/or a person with ultimate authority over the account.

Name:
Phone:
Fax:
eMail:
Position of Administrative contact: (e.g 'Manager')
          
Technical Contact:
(use "as above" as necessary)

Name:
Phone:
Fax:
eMail:

DECLARATION:

By submitting this application. I declare that I have read, understood and agreed on behalf of the customer to abide by Precisiums Terms & Conditions Version 1.1


Name of person authorised to enter into agreement on behalf of customer:
(required)

Existing email address. This is the address we will respond to.
(required)

Date service required to commence:


 

COMMENTS: