Urban Technology

Order Form

*

"Hosting Plan:

Please choose your preferred Hosting plan

Domain Name Option

*	Existing domain name:		Please enter your existing domain name
	New domain name:		Register a .com, .net, .org, .biz, .info, .co.nz, .net.nz, .org.nz, .ac.nz, .geek.nz, .maori.nz, .school.nz domain through Urban Technology for only $34.00
*	Type your Domain:	e.g. "http://www.yourdomain.co.nz"

Payment Method

*	Payment Period:		Monthly Payments only available via Automatic Payment method
*	Payment Method:

Hosting Account Details

*	Login Name:		4 - 8 Characters
*	Password:		6 - 12 Characters
*	Confirm Password:		6 - 12 Characters

Your Contact Details

*	First Name:		*	Surname:
	Company:(optional)
*	Email:			Insert internet service provider email here e.g. name@xtra.co.nz.
*	Address 1:		*	Phone Number:
	Address 2:			Mobile Number
*	City / Suburb:		*	Post Code:
*	Region/State		*	Country
*	I have read and agree to the terms and conditions set forth by Urban Technology.