web hosting application form

To create a web hosting account at activIT systems, fill out the form below. We'll give you a 30 day money back guarantee that you'll love our web hosting. Accounts usually take about thirty minutes to set up, if the application has been lodged during business hours.


Hosting Package:
The hosting package you require.
Domain Name:
Please enter the domain name you intend to use.
First Name:
Your first name.
Last Name:
Your last name.
Phone Number:
Your day time telephone number (include area codes).
Company Name:
Company name, if applicable.
Email Address:
Your email address. Your account details, invoices, and correspondence will be sent here.
Confirm Email:
Re-enter your email address.
Address 1:
Your postal address.
Address 2:
Additional space for address.
City/Town:
The city or town in which you are located.
State:
The state or territory in which you are located.
Website Description:
A brief description of the website you intend to host with us.
Terms and Conditions You are required to read, and agree to, the Web Hosting Terms and Conditions of Service before you can proceed.

I have read and agree to the Web Hosting Terms and Conditions.