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RESELLER ORDER FORM

To place your order please select one of the following:

1. Pay by Direct Deposit (Preferred): Complete the form below and choose Direct Deposit as your method of payment. We will send you an invoice by email with our Bank Details. Once the funds have been deposited into our account we will process your order.

2. Pay by Credit Card: Complete the form below and choose Credit Card as your method of payment. For your peace of mind we will send you an invoice by email with a direct link to an independent Global third party secure e-commerce provider. Once the funds have been deposited into our account we will process your order.

3. Pay by Cheque: Complete the form below and then print, attach it to your cheque or money order and post to the address listed below:

SupplyLink International
PO BOX 313
Beenleigh Qld Australia 4207

We will contact you with your details immediately the order is processed. 

About You:

 
* Your First Name:
* Your Last Name:
Business Name
(if any):
Business ABN
(if any):
* Current Email Address:
Current Web Site URL if any:
* Street Address:
 
* City:
* State:
* Zip:
* Country:
* Phone: Landline area code & number required
Mobile Phone:
Fax (if any):

About Hosting:

 Fields marked * are required fields. 
Please ensure all these are completed.
Managed Hosting & Support
Australia    US (International Clients)  
Reseller Type
Select your Operating System  Unix       Windows
Package Type:


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Payment Method:
Pre Pay Period:
Is this:
A new domain?
An existing domain ?
Domain name:
Use existing domain and update your own name servers  Yes       No
Unique IP's
Setup AUD$70		 Yes       No
Number of Unique IP's
AUD$8.00 ea/mth
Do you require an SSL Certificate to be installed?
AUD$119.90 p.a.		 Yes       No
You have read and agree to our terms and conditions  Yes       No
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