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  ITCENTRE ORDER FORM/CONTRACT FOR THE HOME PACKAGE

Terms and Conditions

Check that the domain name is not taken Domain name

CREDIT CARD PAYMENT CAN BE MADE BY TELEPHONE 01494 440095 CLIFTON LODGE HOTEL ITCENTRE This is for the yearly amount only of £56.28 The Account will be set up when the payment is received

PAYMENT BY CHEQUE

CHEQUES CAN BE SENT TO US FOR THE PACKAGE. THE CHEQUE MUST BE FOR THE TOTAL YEAR ie £56.28 tick the box BELOW and send your cheque to us. Payable to “Clifton Lodge Hotel (itcentre)” The Account will be set up when the cheque is received.

Clifton Lodge Hotel (itcentre)

210 West Wycombe Road

High Wycombe, Bucks, HP12 3AR 

UK

PLEASE FILL IN THE FORM BELOW AND SUBMIT IT TO US

New Domain Name www.yournewdomain.co.uk For us to register
Alternative New Domain Name www.yournewdomain.org.uk
Domain name already registered that you wish to use as well?
The domain Name you have registered
Can you change the Nameservers
Do you want to tranfer the domain name to us?
Payment Card Number
Barclays Card
Master Card?
3 Digit Security Card Number
Maestro or Solo
Maestro/Solo Issue Number
Please deduct My Card £4.69 per month
Please Deduct My card for one years hosting £56.28
I wish to telephone you with my credit card and pay yearly
I Wish to pay by cheque yearly(Only) £56.28
Name of card Holder
First name
Last name
Address
Zip
City
County
State
Country
Phone
Email
Email Confirm
Comment
I HAVE READ AND AGREE WITH THE TERMS

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