Three steps to the Internet with Netsell:

  1. Please complete all fields in this form. Leave blank where N/A.
  2. Print the form and sign where required.
  3. Send both completed pages to Netsell Internet, PO Box 158 St Peters LPO NSW 2044

Date:

 

Company Name

Contact Name

Postal Address

Suburb/Town

State

     Postcode:

Current Email Address

Phone

Fax

Mobile

RBN

ACN

ABN

DOMAIN NAME

Requested Domain

Registry Key
If transferring existing domain name

Domain Type

# of Email Addresses
Please specify required addresses on page 2

 

 

WEB HOSTING  Please select monthly or yearly payment below

 Pay Yearly

 Pay Monthly

 

E-COMMERCE Don’t forget to also fill out the relevant form for your selected e-commerce package

E-Commerce Plan

 

 

 

Setup Fee  Once-off payment applies to all services

 

TOTAL Up-front Payment

 

GST component


I have read and agree to the terms and conditions set out in the Disclaimer on this website (Netsell.com.au).

Credit Card Type

 

 

Card Number

Expiry Date

/

Name on Card

 

 

 

 

Signature

 

REQUIRED EMAIL NAMES for your domain name

eg: admin@yourcompany.com.au, sales@yourcompany.com.au, johnsmith@yourcompany.com.au
Use overleaf if necessary.

 

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A GST invoice will be sent to you confirming your registration and receipt of payment.