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- 1. Tourist Facilities Pty Ltd ABN: 77 001 189 153 Domain Name & Hosting Application Form Date: ______/_______/______ Register New Domain Name Transfer Existing Domain Name Yearly Hosting Domain Name Information Domain Name: ____________________________________________________ (eg: yourcompany.com.au) Registry Key: ____________________________ (Required for Transfer of Domain Name) I warrant that I am: The Owner / An Authorised Employee / An Authorised Agent I hereby request and authorise Shoalnet/Fastrac Internet Services to change the delegation of the above domain name from the current Nameservers to Shoalnet/Fastracs Nameservers. I am also aware that my Domain Name will be transferred across from the current registrar across to Enetica Pty Ltd. Registrant / Company Information Company Name: _____________________________________ ABN/ACN/Bus Reg: _____________________________________ (Required for .au Domains) Owner Type: Company Sole Trader Partnership Other (Required for .au Domains) Contact Name: ____________________________ Position: ____________________________ Physical Address: _______________________________________________________________________ Postal Address: _______________________________________________________________________ Phone: (____)_______________________ Fax: (____)_______________________ E-Mail Address: ___________________________________________________ Authorised Contacts: Name, Phone & Position:______________________________________________ (The above authorised contacts can request information and make changes regarding the Domain Name and Hosting) Hosting Do you require a catchall Address? YES NO If YES please specify the Catchall address: __________________________________ (Note: This does not have to be a Shoalnet/Fastrac address or your Domain E-mail address. A catchall address is an E-Mail address that any unassigned E-mails to your domain get sent to. Eg: If you do not have sales@yourdomain.com.au setup on your domain, any E-Mails sent there, will be directed to the catchall address. Catchall addresses tend to receive quite a bit of spam as spammers will try to send to random addressees eg admin@yourdomain.com.au, info@yourdomain.com.au and so on. POP E-Mail Addresses: 1 ________________________@yourdomain Password: __________________ 2 ________________________@yourdomain Password: __________________ 3 ________________________@yourdomain Password: __________________ 4 ________________________@yourdomain Password: __________________ 5 ________________________@yourdomain Password: __________________ (Please attach a separate sheet if you require more than 5 addresses) DA010707 Shop 3/50 Berry Street, Nowra or P.O Box 1137, Nowra, NSW, 2541 Phone: (02) 4422 5014 Fax: 4422 5016 Email: sales@shoal.net.au Homepage www.shoal.net.au
- 2. Tourist Facilities Pty Ltd ABN: 77 001 189 153 E-Mail Forwards: 1 ________________________@yourdomain forwarded to __________________________ 2 ________________________@yourdomain forwarded to __________________________ 3 ________________________@yourdomain forwarded to __________________________ 4 ________________________@yourdomain forwarded to __________________________ 5 ________________________@yourdomain forwarded to __________________________ (Please attach a separate sheet if you require more than 5 addresses) Do you require a MySQL Database? YES NO Pricing Yearly Hosting $200.00 (1 Year) .com.au, .net.au, .co.nz, .org.nz, .net.nz $85.00 (2 Years) .id.au, .org.au, .asn.au $44.00 (2 Years) .com, .net, .org, .biz, .info $50.00 (2 Years) Payment Method Credit Card Visa Mastercard Bankcard Amex (Please Circle) Card Numbers: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiry Date: ___ / ___ Name on Card: ___________________________________ Signature: __________________________ Tick if you wish to have Domain Registration and Hosting taken from CC automatically when due. Direct Deposit Account Details: BSB Number: 062585 Account Name: Tourist Facilities Pty Ltd Account Number: 28039411 Cheque Post to P.O Box 1137, Nowra, NSW, 2541 or drop into the office 46 Berry Street, Nowra, NSW, 2541 Terms & Conditions By submitting this application for a Domain Name and/or Hosting, you confirm that you are eligible to hold the Domain Name set out in this application, and that all information provided in this application is true, complete and correct, and is not misleading in any way. If any information is later found not the be true, or is incomplete, incorrect, or misleading in any way, or if you have submitted this application in bad faith, the Domain Name licence can be cancelled and you can permanently lose the use of the Domain Name, with no refund given. You must give 14 days notice in writing to cancel the hosting of your Domain. Bound by the Terms and Conditions, copy available on the Shoalnet/Fastrac Homepage at http://www.shoal.net.au/customer/tnc.html or available from the Front Office at 46 Berry Street, Nowra, NSW, 2541. I, ______________________________ agree to the above terms and conditions. Signed: _________________________ Print Name: ______________________ Date: _____/_____/_____ Fax back form to (02) 4422 5016 Shop 3/50 Berry Street, Nowra or P.O Box 1137, Nowra, NSW, 2541 Phone: (02) 4422 5014 Fax: 4422 5016 Email: sales@shoal.net.au Homepage www.shoal.net.au