NetSA Order Form

This order form is only for new customers...

This form is best viewed when maximised in your browser

Step 1: - Choose your products / services
Do you want NetSA to register you domain name for you?		Yes		No	*Compulsory yes or no
	If YES then please supply:	DOMAIN NAME:			e.g. mydomain.co.za


Choose a Hosting Package		Domain Parking				R 60-00
		Ultra Mini				R 60-00
		Mini				R100-00
		Maxi				R160-00
		Ultra Maxi				R250-00

Fax 2 Email service		Yes		No		*Compulsory yes or no R 30-00
	If YES then please supply:		Email address to use

Step 2 - Supply the following personal details:
First Name	*Compulsory field
Surname	*Compulsory field
Postal Address	*Compulsory field


	*Compulsory field
Postal code	*Compulsory field
Telephone number
Cellular Number
Fax Number
Preferred calling name	*Compulsory field
Email address to contact you on:	*Compulsory field

Step 3 - Answer the following questions
Have you read, and agree to the Acceptable Use Policy?				*Compulsory to accept
Have you read, and agree to the Customer Service Agreement?				*Compulsory to accept
Would you like to receive the NetSA newsletter?	YES		NO

Step 4 - Click on 'Order' to submit your order