Order Form

Sales:	+65-6734-5448
SMS:	+65-9062-4238
Email: sales@cyberheart.net Support: tech@support.net

We will respond with a confirmation order WITHIN 12 HOURS.
Should you not hear from us, please Tel: +65 - 67345448.

Please complete all fields:

Name
Title
Company
Street Address
Address 2
City
State
Province
Zip/Postal Code
Country
Work Phone
Home Phone
Date of Birth
Select Services:
Domain Name	Type :
New Domain Registration#
Server Type
Hosting Plan
Options:
Payment Method
Payment Plan	(2 years - Save 2nd Year Domain Name Registration)
Comment
E-mail

# When you request us to register the domain on your behalf, you will agree to
our "Uniform Dispute Resolution Policy" and "The Terms and Conditions" for domain registration on your behalf.

* Payment - Local Order Payment by direct bank credit, check or cash only. If you are paying by credit card, you can login to our payment provider and return to complete this form. The geographic location of your computer has been determined and recorded. Card fraud is a criminal punishable by heavy fines and jail time.

When you select our hosting plan, we can register your domain name (.com.sg/.com/.org/.net/.biz/.tv/.cc/.info/.cn)
so that your account can be setup within 24 hours. If you select 'transfer' the Domain name registration, you need to email us the Registrar URL, User ID and Password for us to change the Domain Name Server (DNS).

IN WITNESS WHEREOF, the parties hereto, intending to be legally bound hereby, and in consideration of the covenants and agreements contained herein, do hereby execute this instrument, with each party warranting their ability to enter into this Agreement for the person or entity herein named as a party hereto. By filling out the on-line application directly or by placing an order telephonically and clicking on "Accept" below, Customer agrees to all the terms and conditions of this Agreement.