<%@ Language=VBScript %> <% dim item,name,senderemail,subject,recipient,body,newline,jmail newline = chr(13) + chr(10) For Each item In Request.Form ' This will extract every form element from the previous from page and print them ' in the body of the message with the label name and it's value on ' seperate lines body = body & item & " : " & Request.Form(item) & newline Next 'The name in front of the email address Name = "Global Webpage" 'Please specify a correct address for the email Sender 'Can be anything as long as it is valid otherwise it may not work Senderemail = "admin@angkriswebdesign.com.au" 'subject for the email Subject = "Angkriswebdesign - Hosting Order" 'Type in your email address Recipient = "admin@angkriswebdesign.com.au" Set JMail = Server.CreateObject("JMail.SMTPMail") JMail.ServerAddress = "mail.angkriswebdesign.com.au" JMail.Sender = Senderemail JMail.Subject = Subject JMail.AddRecipient Recipient JMail.Body = Body JMail.Priority = 3 JMail.AddHeader "Originating-IP", Request.ServerVariables("REMOTE_ADDR") JMail.Execute %>

Domain Name / Hosting Order Form
 
 

First Name:
Last Name:
 Street name & no:
Suburb, city, pcode:
State:
Country:
Other Country:
Email Address:
Contact Phone no:
Fax no:
Business name:
                    
Domain Name Details:



www.  
please type in name with extension.

New domain name

Redelegate

If purchasing a domain name place total cost here.
$
Domain Ending: 

.com
.net
.org
.com.au
.net.au 
.asn.au                
.org.au 
.co.uk
.biz
.info
Cost (inc GST)

$42.90 p.a.
$42.90 p.a.
$42.90 p.a.
$137.50 2yrs
$137.50 2yrs
$137.50 2yrs
$99.00 2yrs
$110 p.a.

$110 2yrs
$110 2yrs

Select Web Hosting  Plan:



hosting rates/plans for reference.
Prices Include GST.

 
Starters AU $165 yearly
Business 1 AU $275 yearly
Business 2 AU $375 yearly
Developer AU $580 yearly
Ultimate AU$770 yearly
Please type the total amount payable: $    
Add the total costs: (host plan + the cost of a new domain name if applicable.

Prices are quoted in $AU and include GST. If outside AU - convert to your countries currency.
Select Payment Method:
  
We accept Electronic Funds Transfer (EFT), Cheque or Visa, MasterCard or Bankcard.
If paying by EFT or Cheque please leave credit card details blank. A tax invoice will be issued with payment details.

Fill name on card:  First       Middle       Last
 
Type: Visa    Bankcard  Mastercard
Card Number:
Expiry Date Month   Year
Subscriber Agreement: (please tick)
I have read and agree to domain name registration and hosting policies.


_________________________________________________________________

Web Design | Web Hosting | Website Promotion | Domain Names Australia
Private Policy | Contact US


Main Website Design Production Office
Coolum Beach, Sunshine Coast, Noosa, Brisbane, Queensland.
Ph: 07 5471 6064
Email: admin@angkriswebdesign.com.au


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Website Design by AU Web Group