Windows Dedi Server Order Form Suited for eCommerce, Corporates, and Government Sites. Please enable JavaScript in your browser to complete this form.Select Services Required - Step 1 of 5DEDICATED WINDOWS SERVER ORDER FORMSuited for eCommerce, Corporates, and Government sites.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 DETAILSDedicated Windows Server Hosting Solutions *Bronze (small & affordable) - R 4,999.99Silver (most popular - More Storage, More Speed, More Power) - R 5,999.99Gold (built for high-performance sites) - R 6,999.99Billed monthly using a debit order collection. Min 12 month commitment.Once-Off Setup Fee *Price: R 1,800.00Do you want us to Register a domain to your server? *YesNoDo you want us to Transfer a domain to your server? *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 920.00.durban - R 920.00.capetown - R 920.00.africa - R 920.00Renewed 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 monthlyOnce-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.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 AgreementI 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