PERSONAL DETAILS

DEBIT ORDER DETAILS

* Denotes a required field

Select Product *

R1000 Once off setup thereafter R99 pm for 12 months.
R1750 Cash Deal (includes 12 months of free hosting).

Offer Inclusive of VAT and the following:

• Domain Registration (www.yourbusinessname.co.za)

• 4 Page Website Design

• 100 Email Accounts (yourname@yourbusinessname.co.za)

• Flash or Slideshow Image Presentation

• Search Engine Optimisation (google, yahoo etc.) SEO Analytics

• Social Networking Links (facebook, twitter etc)

Customer name *

Trading name *

ID Number or Business Registration Number *

Email address *

Postal address *

Physical address

Suburb

Postal code

Telephone *

Fax

By completing this and accepting the terms and conditions, the customer/its representative hereby authorises Astral Media to debit from the account specified below:

Monthly Service Fees (including any pro-rata amounts or any Service Fees charged monthly) or any such overdue Monthly Service Fees (including relevant interest and / or charges in terms of the Agreement) on the specified debit date of each calendar month; or

Annual Service Fees or any such overdue Annual Services Fees (including relevant interest and / or charges in terms of the Agreement) on the specified debit date of each calendar month following the commencement of the Agreement or the Service and annually thereafter. This authority will remain in full force for the duration of the Agreement and any extensions thereof or whilst any amounts, including Service Fees remain outstanding.

Bank name *

Account holder *

Branch code *

Branch name *

Account number *

25^th Last working day

I agree that I have read and understand the terms and conditions