Saco Technology - Web Hosting and Domain Name

Complete the Web Hosting & Domain Name application form below

Agent (Optional)

Promo Code (Optional)

First Name

Last Name

Date of Birth - DD/MM/YYYY

Drivers Licence/Passport Number

Business ABN (Optional)

Business Name (Optional)

Address

Suburb

State

Post Code

Phone Number

Fax Number

Mobile Number

Email Address

Please enter your desired username and password below. These details will be used to allow you to access your account online.

Username

Password

Plan

Yes I would like Virus Scanning at $99.95 a year

Yes I would like Virus Scanning at $9.95 a month

Yes I would like Spam Filtering at $99.95 a year

Yes I would like Spam Filtering at $9.95 a month

Place enter the domain name/s you wish to purchase in the box below. Example www.sacotechnology.com.au

Place transfer the following domain/s from my current provider (Only required to complete if you currently have a domain)

Transfer Domain

Current Domain Provider

Username

Password

How did you hear about Saco Technology?

How would you prefer to be notified about the progress of your application? ?

Please complete the payment details below selecting either credit card or direct debt as your preferred payment option

Your selected payment method will be charged for your first months hosting and or domain on completion of this application form

Payment Method

Mastercard

Visa

Direct Debit

Name on Card

Card Number

Expiry Date - MM/YY

Please complete the details below if you selected direct debt as your payment option above

Account Name

BSB

Account Number

I authorise and request the debit user detailed below to debit payments from my nominated account, as specified below, at intervals and amounts as directed by Saco Technology as per the Terms and Conditions of the Saco Technology agreement and subsequent agreements. I/We authorise Saco Technology to debit my/our account at the Financial Institution identified above through
the Bulk Electronic Clearing System (BECS) in accordance to the Payment Details stated above or detailed in separate agreement and as per the Terms and Conditions provided. The administration of this agreement is conducted by Saco Technology and its third parties. The services provided by Saco Technology are administrative to the status of the Agreement and do not extend to the provision of any services or benefits of the Agreement as provided by the Business. This authority shall be interpreted and enforced pursuant to the laws of the state of Queensland. The Financial Institution may, in its absolute discretion, determine the order of priority of payments by it of any monies pursuant to this request or any other authority or mandate. Saco Technology or its third parties will provide 14 days notice if the payment amount (s) of frequency of the payments vary for future debits. It is your responsibility to ensure that you have sufficient clear funds in your nominated account to enable the direct debit to be honoured by your financial institution. Direct debits normally occur overnight; however transactions can take up to three (3) days depending on your financial institution. If your Debit request falls on a weekend or public holiday, it will be processed on the next working day. You are advised to verify account details against a recent bank statement and if uncertain you should contact your financial institution. If your Direct Debit is dishonoured or returned by your financial institution, for any reason, Saco Technology reserves the right to charge a dishonour fee, and re-present the Direct Debit for processing again on the next business day. Any dispute arising from this or subsequent direct debits are to be directed to Saco Technology on 1300 664 186 or in writing to the address provided above, or you may contact your financial institution If no resolution is forthcoming you are advised to contact your financial institution. If you lodge a DDR Customer Claim form with your financial institution they will investigate whether the transaction was authorised by you. If the transaction date was no earlier than 12 months from the date of your claim you should receive a response within 7 days from the date of your claim. If the transaction date was made earlier than 12 months from the date of your claim you should receive a response within 30 days from the date of your claim. We will keep your information about your nominated account at the financial institution private and confidential unless this information is required to investigate a claim made in relation to an alleged incorrect or wrongful debt, or otherwise required by law. You may stop, cancel , alter or defer your Direct Debit Request at any time, by contacting your Financial Institution or by providing at least 14 Business Days written notification to Saco Technology at the address detailed below. I/We authorise the Debit User to verify the details of the abovementioned account with my/our Financial Institution. I/We authorise the Financial Institution to release information allowing the Debit User to verify the abovementioned account details. I/We agree to accept payment notifications from the business by either E-mail or SMS as determined by the business. If I do not wish to receive such notifications I will contact the business directly so as to be omitted from such notifications.

I/We understand all services provided by Saco Technology must be paid in advance except by written agreement with Saco Technology management. If an account is not in credit, the account may be disconnected at the discretion of Saco Technology. Saco Technology will always aim to provide the best and most reliable service possible, but cannot be responsible for any loss of service, regardless of whose fault it is. Each user is responsible for the usage on their account. Passwords and usernames must not be shared. Any breach of this condition will lead to immediate termination of the account without refund. The account will not be used for any illegal or anti-social purposes, including obscene, abusive, fraudulent, threatening or otherwise unacceptable messages or usage. I/We have read and understood Saco Technology�s General Terms and Conditions and our Domain Name and Hosting terms and condition (as displayed at www.sacotech.com.au or as sent to me/us by Saco Technology at my/our request) and agree to abide by them. I/We also verify being over the age of 18.

Full Name

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Date - DD/MM/YY

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