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Managed Email Hosting Order

To apply for HostSG Email Hosting Services, please fill in the online form below with accurate information. The information will be kept confidential and only for HostSG use only.

Sign Up Instructions
Sections in bold denote required field, while you may skip section which has 'optional' at the top.

Reseller Information (optional)

For HostSG Reseller Only

Please fill in the information required if you are a HostSG Reseller, otherwise you may skip this section.

Are you a HostSG Reseller?
Reseller Organisation/Name :
Reseller ID :
Number of account including this account :

Domain Name Information

Please Select your Domain

Please select New Domain Registration or Domain Name Transfer

Please enter domain name (eg. abc.com)

Domain Name Period:

Additional Domain Information (optional)

For any additional domains that you wish to register or transfer to HostSG, please type in the space provided below. Skip this section if not applicable.

Register these domains below for me
Transfer these domains below to HostSG for me

Email Hosting Plan Information

Select Your Email Hosting Plan

EMAIL HOSTING PLAN
	Managed Email Hosting	Monthly	Setup Fee	Email Users
	10 GB Space	S$400.00	$400.00	Unlimited

Registrant Information

Billing Address and Contact Information

Name:
Company Name:
Company Registration Number :
Primary Email Address:		Secondary Email Address:
Home Phone Number:		Work Phone Number:
Mobile Number:		Fax Number:
Address:
City:		State/Province:
Country:		Zip/Postal Code:

Billing Information

Select Your Payment Method and Service Term

Services Term :	Annually (12mth) 10% discount Bi-annually (24mth) 15% discount

Payment Method :	Cheque/Checks Local Bank Fund Transfer (DBS/POSB) Money/Post Order International Bank Fund Transfer (Extra S$50 surcharge) Credit Card via Paypal (rate will be charged at 0.80 USD)
	Credit Card via Paypal will be accepted for payments in USD rate at (SGD 1 = USD 0.80) [Due to transaction fees]

Please Let Us Know(optional)

General Information

Please fill in the information required to take advantage of HostSG existing customer privilege.

Are you an existing customer? :
Current Domain :

How did you found out about us? :

Comments, Remarks, Special Instructions :

By submitting this form , you are agreeing to

:: authorize HostSG to process this server order in accordance with the terms stipulated below.

:: verify that the contents provided above, including payment details are accurate.
authorize HostSG to process my payments as specified above.

:: the terms of service, AUP, and billing policy previously set forth by HostSG.

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