1. Agent Use Only Domain Name and Hosting
Town: Townsville Westnet Pty. Ltd. ABN: 50 086 416 908
Agent: Dennis' Computers A598 Level 7, 152 St George’s Tce, Perth, 6000
Hosting Sales Person: Dennis Evans GPO Box C121 Perth 6839
Phone: 08 6263 6300 Facsimile: 1300 554 160
Domains & Hosting: 1300 137 480 Accounts: 1300 855 006
New or Existing Member Details
Full Name (contact name if business): Are you an existing customer ?
 Yes  No
Date of Birth: Organisation: ABN:
Address:
Suburb/Town: State: Post Code:
Home Ph: Work Ph: Fax No: Mobile:
Email Address: Westnet Username (If Applicable):
How did you hear about Westnet Hosting?
Domain Details (If transferring a domain, please skip this step)
Domain Name:
Important Domain Information Payment Options
 .com.au $88 - 2 year registration  .com $30 - 1 year registration
If the domain name is not directly derived from your Business name, please outline the connection
between your business name and the domain name requested i.e Domain name is a product or service
we sell etc:
 .net.au $88 - 2 year registration  .net $30 - 1 year registration
 .org.au $35 - 2 year registration  .org $30 - 1 year registration
 .asn.au $55 - 2 year registration  .info $30 - 1 year registration
 .id.au $45 - 2 year registration  .biz $30 - 1 year registration
Transfer & Renew My Domain with Westnet Hosting (If registering a domain please skip this step)
Domain Name: Domain Password:
Hosting Option
Options Extra Requirements
Basic Web Hosting  Monthly - $16  Annual - $160 If you would like to have your emails protected from viruses and/or spam please tick the boxes below.
Business Web Hosting  Monthly - $22  Annual - $220 EMAIL VIRUS SCANNING $99 per domain per annum
 The email antivirus service works by scanning all your incoming mail for viruses. If a virus is detected, the entire mes-
Corporate Web Hosting  Monthly - $28  Annual - $280 sage is quarantined on Westnet’s servers and a notification message is sent to you detailing the infection.
EMAIL SPAM FILTERING $49.95 per domain per annum
Premier Web Hosting  Monthly - $33  Annual - $330
 Spam can be difficult to detect; hence the prevention of spam can also be very difficult. The method we will be using
does not guarantee that you will not receive any spam, but it will significantly reduce the amount of spam you receive.
Basic Mail hosting  Monthly - $16  Annual - $160
Preferred Server
Mail Hosting  Monthly - $22  Annual - $220
Please select either Windows or Linux as a web server to host your website. If you are not sure which web
DNS Hosting   Annual - $66 server is best for you, chances are that either will do. Unless you specify your choice of web server Westnet
Hosting will create your web hosting account on the Windows web server.
Secondary DNS Hosting   Annual - $27.50
 Windows Server (default)
Domain Mirror   Annual - $25  Linux Server
Payment Details
Credit Card Type:
 Ongoing Credit Card Deductions   
Name on Card:
Please supply credit card details here
Card
 Ongoing Direct Debit Deductions No:
Expiry: Signature: Date:
Please complete separate direct debit form. Call 13 19 60 or go to http://www.westnet.com.
au/internet/signup/applications.aspx for form
Declaration
• I have read and agree to Domain registration Warranty Statement and agree to enter into the Registrars Agreement found at http://www.westnethosting.com.au/aboutus/additional_policies.shtml
• I have read and understood Westnet Hosting Terms and conditions found at http://www.westnethosting.com.au/hosting/terms_and_conditions.shtml and Westnet’s General Terms and Contitions.
Name: Your Signature: Date:
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