ICONZ Web Hosting Signup

This form is for both business and residential customers.

Personal Details
Your Email Address      
Are you an existing ICONZ customer?     No     Yes, my account number is:

Service Details
Please select the plan you require:
  Plan/Disk Space Monthly Fee Excess MB
Web Hosting 5MB $10.00 $1.10 /MB
Web Hosting 10MB $15.00 $1.10 /MB
Web Hosting 30MB $20.00 $1.05 /MB
Web Hosting 60MB $45.00 $0.80 /MB
Web Hosting 120MB $100.00 $0.50 /MB
Web Hosting 240MB $150.00 $0.30 /MB
Prices exclude GST.

Platform Type
Your platform type Windows   Linux  

Domain Name Details
If you require a domain name for your website, please click here
Do you wish for ICONZ to become the Registrar of your Domain Name?
Yes No

General Information
Where did you hear about ICONZ?
Word of Mouth   Web Search   Leaflets   Radio   Newspaper  
Other - please specify:

Payment Details
Credit Card
Direct Debit
Direct Credit

Please Contact our account team to make arrangements to pay by credit card
Download Direct Debit form here*,
or contact ICONZ to have one faxed or emailed to you)
*You might need to save this form into your computer.
*You will need Adobe Acrobat to open this form, click here to open the Adobe Acrobat download page.
Our bank account no. is
National Bank 06-0287-0739135-00
Please use your Account No. as reference

Comments
Any additional notes?

Terms & Conditions
The Service Agreement Terms & Conditions can be found on the ICONZ website at www.iconz.net/company/legal

By submitting this document:
(a) You request ICONZ Limited to supply the Service on these terms and conditions.
(b) You acknowledge and declare that you have read and understood the terms and conditions.
(c) You acknowledge that the Service Request Date specified herein (if any) is an estimate only.

You must be over 18 years of age to submit this Service Agreement and Specification document. If you are under 18, the account must be in the name of Your parent or guardian or a guarantor 18 or over, who must also be the person who enters their name below.
I agree to the above Terms & Conditions
Your Full Name