Application - Web Hosting

Web Hosting Application: Please complete the following form then click submit. * indicates a required field.

Full Name: * Billing Address: *
Current Email Address:

 Phone Number:

 *
Mobile Number:

 Fax Number:
Package Required:

 ADSL and Dial-Up Service:
New Domain Name
If required: www.

 Email Virus Protection:

  This service is now included
 in all Solution packages.
List alternatives in case yours is already taken.
  		FrontPage Server Extensions @ £26 + VAT per annum:  
Other Domains
If required:
Please list all
£10+VAT per annum
per domain (includes
redirect to your
main site)		 Matrix Statistics installed on web site @ £15 + VAT per annum:  

 Note: Included with Business Solution
 package
Domains to be transferred:
£10+VAT per annum
parking fee


 I agree with the Terms
and Conditions.
Note: No application will
be processed unless
you check the box.		  I agree:

 View Terms and Condtions
Username for Dial-Up Account:
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Longcrest Systems Ltd, Park Lane House, 7 Park Lane, Sutton Benger, Chippenham, Wiltshire, SN15 4RN, United Kingdom
 
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