SMME Website Development Order Form Suited for Startups, Small & Medium Businesses, or Individuals. Please enable JavaScript in your browser to complete this form.Select Services Required - Step 1 of 6SMME WEBSITE ORDER FORMSuited for Startups, Small & Medium Businesses, or Individuals.Sign up as *Individual CustomerBusiness CustomerNextAPPLICANT INFORMATIONName *FirstLastEmail *Cell Phone *Landline NumberAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryCompany / Organization Name *CK/Company Registration Number *Upload Company (CIPC) Certificate & Director/Member ID * Click or drag files to this area to upload. You can upload up to 2 files. Only pdf file format acceptedVAT NumberVAT Registration Certificate Click or drag a file to this area to upload. Only pdf file format acceptedPreviousNextPRODUCT DETAILSSMME Website Packages *Basic (1 page design) - R 999.00Professional (5 page design) - R 3,999.00Premium (5+ to 25 pages with CMS Design) - R 7,999.00*eCommerce (10 page design) - R 12,999.00Design and Development are once-off fees per website * e-Commerce sites are subject to a full content and pricing analysis before sign up and commencement at the prescribed rate.Do you want us to Register & Host a domain? *YesNoDo you want us to Transfer & Host a domain? *YesNoDomain Name(s) to Register or Transfer *example www.mydomain.co.za, www.mydomain.com ( for more than one domain name, separated with a comma). New domain name applications will be checked for name availability first before confirming registration. Please list at least 3 names in order or preference for us to check.Popular Domain Extensions.co.za - R 100.00.com - R 520.00.org.za - R 100.00Renewed and billed annuallyLocation Type Domain Extensions.joburg - R 520.00.durban - R 520.00.capetown - R 520.00.africa - R 520.00Renewed and billed annuallySpecial Domain Extensions.org - R 520.00.net - R 520.00.info - R 520.00.biz - R 520.00.mobi - R 520.00.de - R 520.00.eu - R 520.00Renewed and billed annuallyOther Domain Extensions.co.uk - R 899.00.tv - R 899.00.co - R 899.00.cc - R 899.00Renewed and billed annuallyHIT Cloudbrick FirewallMonitored Firewall - R 300.00Optional Service Billed monthly Preferred for e-Commerce sites to secure and protect online transactions and browsers.Once-off Costs *.co.za Domain Transfer - R 287.50All other Domain Transfer Extensions - R 520.00Domain Parking - R 287.50Create Sub Domain - R 287.50Charges are billed per domain.Business Hosting Solutions *Bronze - R 100.00Silver (most popular) - R 131.00Gold - R 410.00Platinum - R 510.001 - Billed monthly. 2 - Subjected to per domain extension or parking. 3 - The total number of domains registered/transferred will be evaluated by our sales team. 4 - An official quotation for Shared Hosting services will be sent before the services are confirmed.NextUpload Website ContentThis information is for the initial scope. Upload Logo Click or drag a file to this area to upload. 1 - Upload a high-resolution web optimised version of your Logo. 2 - Your Logo must be on a clear (not white) background in a PNG file format. 3 - No other format will be accepted.Upload Company/Profile Click or drag a file to this area to upload. 1 - Company Profile with the following information - About, Mission, Vision, Company History, Management, Services, Products, Contact Information. 2 - This information is for the initial scope. 3 - Our Business Analyst will contact you to discuss your website content requirements. 4 - Only MS Word file extensions will be accepted.PreviousNextBANK AUTHORISATION1 - Download the Debit Order Mandate/Instruction. 2 - Upload the completed form for processing. <<< Click Here to Download the Debit Order Mandate/Instruction>>> Upload Debit Order Mandate/Instruction * Click or drag a file to this area to upload. Upload the signed debit order instruction (pdf format)Bank Account Verification Upload * Click or drag a file to this area to upload. Only a Bank Verification letter in pdf format will be accepted.Debit Order Mandate Agreement *I AgreeI hereby request and authorise Haimsa iT to draw against my account with the above mentioned bank (or any other bank or branch to which I may transfer my account) the collective sum stated from the services I selected above annual and/or once-off; or any variable amount pertaining to this agreement. This being the amount necessary for the payment of the annual/once-off premium due to Haimsa iT in respect of our purchases/ contract/ agreement selected above. All such withdrawals from my bank account by Haimsa iT shall be treated as though they had been signed by me personally. I understand that the withdrawals authorised here will be processed by First National Bank and I also understand that the details of each withdrawal will be printed on my bank statement. I agree to pay any bank charges relating to this debit order instruction. Furthermore I agree that should the bank dishonour any payment to Haimsa iT, Haimsa iT shall be entitled, over and above the dishonoured payment as well as bank charges, be obliged to pay an additional administration fee of Fifty Rands (R50.00) per failed transaction. This authority may be cancelled by means of giving Haimsa iT thirty days’ notice in writing, but I understand and acknowledge that I shall not be entitled to any refund of amounts, which have already been withdrawn whilst this authority is in force if such amounts were legally owing to Haimsa iT. I acknowledge that I may not delegate any of my obligations in terms of this contract/authority to any third party without prior written consent of the Haimsa iT. I warrant that I am an authorised representative and legal entity of the Customer and duly authorised hereto to sign and accept this agreement. I acknowledge to have read, understood and agree to be bound by the standard terms and conditions of this contract agreement and that of Haimsa iTs other agreements; a copy of which is available online at www.haimsait.co.za. Furthermore I declare that the information provided herein is true and correct.PreviousNextTHE ESTIMATED TOTAL FOR THIS ORDER IS:R 0.00TERMS OF SERVICE *I AgreeI, THE CUSTOMER HEREBY AGREES THAT ALL SERVICE/S PROVIDED PURSUANT TO HAIMSA IT’S ACCEPTANCE OF THIS APPLICATION FORM WILL BE SUBJECT TO HAIMSA IT’’S STANDARD TERMS AND CONDITIONS WHICH ARE AVAILABLE AT WWW.HAIMSA IT.CO.ZA OR ON REQUEST AND WHICH ARE EXPLICITLY INCORPORATED INTO AND FORM AN INTEGRAL PART OF THE AGREEMENT BETWEEN MYSELF, AND/OR MY COMPANY AND HAIMSA IT.DATE OF SUBMISSION *PreviousSend Message