BUSYHOSTING APPLICATION - PRINT FOR MAIL OR FAX ONLY
To apply online, click here for our secure online application.
Please type the information where required, then print for mail or fax.
Domain Name:     www.  *
Your Domain Name must be already registered.  if not - Register Here
Registered through:     BusyWeb Domains     Other Company
Front Page Extensions:    Not Required     Required
If unsure, leave as "Not Required" as they can be added later at no charge.
Administration & Billing Contact (Required *)
Title:   Full Name/s:  
   *
Company/Organisation:     
Address:      *
     
Suburb/City:      *
State:  
   * P/Code:    *
Country:      *
Phone: * Fax:
Email: *
Select Charge Amount and Hosting Plan:
*
AUD$30.00 once only setup fee included.
Please deduct my domain registration cost or $19.50 for the "Free Domain Name" promotion.
Before proceeding you must agree to our Terms and Conditions of Service:     I Agree  *
Choose Payment Type:
Direct Deposit to our Bank:           We will forward our account details to your email address.
OR
Cheque or Money Order Enclosed:   
OR
Credit Card Details
BusyHosting is based in Australia. Regardless of your country of origin, we will charge your card in Australian Dollars at the price specified for the domain and duration you require. Your credit card providor will convert the charge to your local currency at the current exchange rate on the day of processing. Your statement will show a charge from AVMedia.
Name on Card:        
Card Number:     
Expires:   Month:   Year:  
Please Note: All amounts in Australian Dollars.
Before proceeding, please check the details you have entered above, then click on "Print This Page".
Your hosting details will be sent to the email or postal address you have entered above.

     
Credit Card or Direct Credit, fax BusyWeb at:
Local:   (07) 5574 0209
International:   +617 5574 0209 		Post with your cheque etc. to :
BusyHosting , 9 Surfers Waters, 40 Cotlew St. East, Southport, Qld. 4215, Australia.
Cheques etc. should be made payable to A V Media.