Online Application Form
 
Hosting Solutions
 
Personal Information
Name & Surname: *
Company:
VAT number (if relevant):
Company Contact:
ID / Company Registration Number: *
Email Address: *
Telephone Number: *
Fax Number:
Mobile Number:
Postal Address: *
 
Service Requirements & Cost
Please indicate your choice of hosting solution by selecting from the list below *
 

Hosting Space

Monthly Cost

Annual Cost
Sand Dollar   4.5 MB    R59    R649
Seahorse   7.5 MB    R75    R825
Starfish   15 MB R129 R1419
Seal   30 MB R179 R1969
Shark 100 MB R349 R3839
Dolphin 300 MB R449 R5489

Domain Hosted Details
Domain to be hosted: *
(Example: mydomain)
(Not: mydomain.co.za)
   Domain TLD: *
(Example: .co.za | .com | .net)
(Not: mydomain.co.za)
   This Domain: *
(please select one)
Has not yet been registered
Exists; transfer to Popular Demand
 
Add-On Services Requirements & Cost
Please indicate your choice of add-on hosting solutions by selecting from the list below *
 
 

Monthly

Annually

 Notes
ASP/PHP
Scripting		    R50    R500 Free with solutions:
SHARK, DOLPHIN
Database Hosting
MySQL / MS Access		 R169 R1690 Includes 20MB database hosting space
Web Site
Traffic Statistics		    R30    R300 Free with solutions:
STARFISH, SEAL, SHARK, DOLPHIN
Web Site
Sub Hosting

R129
     once-off

 Only Available with solutions:
SHARK, DOLPHIN
 
Payment Options & Direct Deposit Details
Payment Options * Direct Deposit Details
Please choose your preferred payment method
Direct Deposit
Monthly Debit Order
Credit Card
A representative will contact you regarding your account details.
Account Holder: Popular Demand Technologies
Account Number: 6202 164 5934
Bank: First National Bank
Branch: The Fountains
Branch Code: 25-79-55
All Deposit Slips to be faxed to 086 686 2622 or sent via email to accounts@populardemand.co.za.
Please include the Invoice Number as reference on the deposit slip/ electronic transfer. We can not be held responsible if the payment cannot be traced.
 

Your Banking Details
Bank Name:    Branch:
Branch Code:    Account Holder:
Account Number:    Account Type:

Credit Card Payments

You will be provided with an invoice number and a secure link for credit card payments,
 as soon as your application has been processed.
 
Confirmation and Submission of Application

By submitting, I agree to the terms & conditions and confirm that all of the information provided in this form is true and correct.

I agree: