MVGL Africa

First Name	Fax Number	Postal Address
Last Name	City / Suburb
Company	Province
Cell Number	E-Mail	Postal Code
Job Title	Phone	Reseller Code

Hosting Package	Domain Type	Domain Name
Design Required	Domain Status	Domain Detail

Existing Clients please enter your Client Code here and fill out Section 2 only.

ADSL	SADSL	Local
56k Dial Up	64k ISDN	128k ISDN

Comments

Please complete only if the Domain will be registered in a Company Name

Business Name

Trading Name

Vat Number

We can transfer your existing Domain to our Servers at no additional Charge. Just select a Hosting Option that suits your needs and fill out this Document. Please note that all outstanding bills have to be settled with your current ISP. This usually takes around 8 to 24 hours depending on the domain that you have currently registered. These times may vary.

Domain Name

Current ISP

Our Sub Domain Hosting is free of charge for Clients having more than five domains hosted with MVGL Africa. You can have any Sub Domain activated within your domain range ie http://www.subdomain.yourcompany.com free of charge.

Hosted Domain

Sub Domain

Payment Option Required (Debit and Credit Card Payers have to fill out the applicable Forms below.

Credit Card Details.
Please note that we only accept Master or Visa Cards at this Stage. Payments will be debited to your Credit Card.

Card Holder Name	Credit Card Type
Card Number	Card Expiry Date

Bank Debit Order Instruction

Account Holder Name	Banking Institution
Branch Name	Account Number
Branch Code	Account Type

Pressing the Submit Form Button verifies that you have read and agree to our Terms & Conditions