Service Activation & Sign-Up Request Form

For Shared Hosting packages

Name/Company/Organization

Enter your name if this is a personal account; else, enter the name of your company or organization.
Passport #/Company or Organization Registration #

Enter your passport # if this is a personal account; else enter the registration number of your company or organization.
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Enter your residential address if this is a personal account; else enter the primary registered address of your company or organization.
Phone

Enter your phone number in this field, inclusive of country code and area code. For example, +65 6440 8690.
Fax

Enter your phone number in this field, inclusive of country code and area code. For example, +65 6440 8790
Customer Account # (if you already have an account with us)

Enter the your account number with us if you already have an account with us.
Contact Person First Last
Enter the name of the contact person for this subscription.
Contact Email

Enter the email address of the contact person in this field.
Billing Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Enter the billing address for this subscription. If it is the same as the address above, you may leave this blank.
Subscription Package

Select the hosting package you'd like to subscribe.