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Register a Domain Name
Please complete the following form. All fields are required.
Domain Details
Required Domain Name (
check availability
)
www.
.com
.co.za
Purchase Price of Domain
R 798.00
Details of Domain Owner
Name of Person or Company Name (if applicable)
ID or Company Registration Number
Postal Address
Street Address
Postal Code
Postal Code
Telephone (business)
Telephone (home)
Fax
Cellphone
E-mail Address
Nature of Business
Details of Domain Administrator
Is the Administrator an existing
Internext
client?
Yes
No
Contact Person
Position
Company Name
ID or Company Reg Number
Postal Address
Street Address
Postal Code
Postal Code
Telephone (business)
Telephone (home)
Fax
Cellphone
E-mail Address
Receive Invoice via
E-mail
Post
Required Monthly Services
Domain Name
hosting (including annual renewal)
R 68.40
Website
hosting
R 136.80
FTP
access
R 68.40
CGI / ASP
hosting
R 74.10
Email
address
R 22.80
X Quantity:
Database
hosting
R 136.80
Total amount per month
R
Debit Order Instruction
Account Name
Bank Name
Branch Name
Account Number
Branch Code
Type of Account
Current
Savings
Transmission
Register a Domain Name
