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Individual
Juridical entity

FULL NAME*
e-mail*
Phone num.
ICQ
Address
Domain name*
	Already taken Register on action
Hosting plan*
Period*
Payment option*
Server*
Dedicated IP (Ukraine (UA-IX) - 5 USD a month, USA, Germany - 2 USD a month)
Attention! When buying hosting service for the period, indicated **, a domain name is not registered free of charge. If the Customer registers a domain name, we’ll include the cost of an appropriate domain into the charges account.
Notes

Domain name*
Hosting plan*
Period*
Payment option*
FULL NAME
Phone
Notes

Server
Administration
Панель:
FULL NAME*
e-mail*
Phone num.
ICQ
Address
Period*
Payment option*
Notes

# server*
Period*
Payment option*
Notes

FULL NAME*
e-mail*
Phone num.
ICQ
Payment assignment*
Total amount USD*
Payment option*
Notes

FULL NAME*
e-mail*
Domain name*
New hosting plan*
Total amount USD*
Payment option*
Notes

Domain name*
Number of Ip*
Payment option*
Notes

Contact person in charge of technical questions (FULL NAME)*

Phone num.*

Fax

e-mail*

ICQ

Technical data:

Domain name*

Already taken

Hosting plan*

Period*

Server*

Dedicated IP (Ukraine (UA-IX) - 5 USD a month,
USA, Germany - 2 USD a month)

Documents:

Customer’s juridical name*

Postal address (if it differs from the registered one)

Postal code:

Position and sirector’s full name:

Договор:

needed

not needed

Is it necessary for payment to have a copy of the original invoice issued?

Yes, make out an invoice, please

No, the documents might be sent after the payment is received by post

Attention! When buying hosting service for the period, indicated **, a domain name is not registered free of charge. If the Customer registers a domain name, we’ll include the cost of an appropriate domain into the charges account.

Payment option*

Notes

Domain name*
Hosting plan*
Period*
Is it necessary for payment to have a copy of the original invoice issued? Yes, make out an invoice, please No, the documents might be sent after the payment is received by post
FULL NAME
Juridical entity
Phone
Payment option*
Notes

Server
Administration
Панель:
Payer’s juridical name*
Contact person (FULL NAME)*
Phone num.*
Fax
e-mail*
ICQ
Postal address:
Street, house, office / PO Box
Location*
Postal code
Is it necessary for payment to have a copy of the original invoice issued? Yes, make out an invoice, please No, the documents might be sent after the payment is received by post
Period*
Payment option*
Notes

server #*
Period*
Is it necessary for payment to have a copy of the original invoice issued? Yes, make out an invoice, please No, the documents might be sent after the payment is received by post
Payment option*
Notes

Customer’s juridical name*
Contact person(FULL NAME)*
Phone num.*
Fax
e-mail*
ICQ
Postal:
Street, house, office / PO Box
Location*
Postal code:
Is it necessary for payment to have a copy of the original invoice issued? Yes, make out an invoice, please No, the documents might be sent after the payment is received by post
Payment assignment*
Total amount USD*
Payment option*
Notes

FULL NAME*
e-mail*
Domain name*
Is it necessary for payment to have a copy of the original invoice issued? Yes, make out an invoice, please No, the documents might be sent after the payment is received by post
New hosting plan*
Total amount USD*
Payment option*
Notes

Domain name*
Number of Ip*
Is it necessary for payment to have a copy of the original invoice issued? Yes, make out an invoice, please No, the documents might be sent after the payment is received by post
Payment option*
Notes

I am aware of (a) rules hosting and accept the conditions

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