Hosting Account Application Form

NOTES:

To activate a new web hosting account with MRM Hosting, please complete the adjacent Hosting Account Application Form. Ensure you fill in all checkmark.gif (306 bytes)entries.

Once we receive your order, we will issue an invoice to you. When payment is received, MRM Hosting will provide your login details and other information.

If this is a New Domain Name you will also need to complete the application form for registering a new domain.
 
If you are transferring your Domain Name from another web hosting provider we will, where possible, arrange the transfer on your behalf. Transfers can take up to 72 hours to complete once they have been approved.
 
We can only accept applications with full contact information. 
 
Any New Zealand Businesses, Registered Companies, Registered or Unregistered Organisations, MUST complete the Business Information section.
 
 
 
Please wait for an acknowledgement from the server before closing your browser or moving onto another web address.
 
SELECT ->  LITE  ECONOMY STANDARD  BUSINESS
Monthly Rate: $14.95 /mo $24.95 /mo $29.95 /mo $39.95 /mo
Quarterly Rate: $13.95 /mo $23.95 /mo $28.95 /mo $38.95 /mo
Half yearly $12.95 /mo $22.95 /mo $27.95 /mo $37.95 /mo
Yearly Rate: $9.95 /mo $19.95 /mo $24.95 /mo $34.95 /mo
Disk Space: 50Mb 100Mb 200Mb 500Mb
Data Traffic: 1Gb/mth 3Gb/mth 6Gb/mth 15Gb/mth
User Accounts: 10 40 100 Unlimited
Sub Domains: None 2 5 Unlimited
mySQL: None 3 10 Unlimited
Web Statistics: 2 2 2 2
Domain Details  

Is this a NEW Domain Name or do you already have a Domain Name?

NEW DOMAIN NAME  
TRANSFER EXISTING DOMAIN NAME checkmark.gif (306 bytes)

Domain Name:

checkmark.gif (306 bytes)

Desired or Existing Login Name:

checkmark.gif (306 bytes)
Max 8 alphanumeric characters

If this is a new application Your password will be automatically generated by the system & sent to you.

Hosting Plan:


NEW PLAN APPLICATION    UPGRADE EXISTING 

Would You Like Any of These Extra ADD ON's

Extra Components You May Require
 mySQL Databases:  No. required:   ($1.00 ea/month)
Email/User Accounts:  No. required:   ($0.50c ea/month)
Disk Space:  Mb required:    ($5.00 100Mb/month)
Data Traffic:  Mb required:    ($5.50 Gb/month)
Sub Domains:  No. required:   ($2.50 ea/month)
SSH Telnet Access:  ADD    REMOVE
 

Additional Information

Comments:

Please indicate which billing cycle you would prefer: MONTHLY    3 Mnth  6 Mnth   YEARLY  checkmark.gif (306 bytes)
Contact Person Information

Your Full Name:

checkmark.gif (306 bytes)

Postal Address:

checkmark.gif (306 bytes)

Telephone:

checkmark.gif (306 bytes)

Fax:

Email:

checkmark.gif (306 bytes)
Business Information
Business Name:
(Australia only) A.B.N.:

Acceptance Information

Referred by:

Comments:

 Type ACCEPT in the box checkmark.gif (306 bytes)to indicate that you have
read & agree to abide by the Terms & Conditions. 

               

 
(Please press once and wait for an acknowledgement)


© MRM Hosting PO Box 145 Ashburton New Zealand      sales@mrmhosting.com