IT / Web Design Service Request
Please complete the form and send back to us.
Full Name:
First Name
Last Name
Organization Name :
Department:
Contact
Provide contact
Building Number:
E-mail:
example@example.com
Services Category:
Computer
Email
Network
Phone
Other
Do you have a website ?
Yes ( if yes what is you url or web addrees)
No
Do you want a new website ?
Yes ( if yes indicate 3 preferred web address eg: www.joe.com below
No ( If no leave blank below
Preferred Website name
example: www. example.com
Software Application Development & Deploy
Please Select
CRM, API Or ERP
Application Development
Custom Software Services
Web Hosting & Design
All of the above
Website Hosting Term
Please Select
1. 3 years renewable domain + hosting K 13000 Professional
2. 3 years Renewable domain + hosting K 11000 standard
3. 12 Months Renewable domain + hosting K 799
4. Starter Pack SME K 399 plus setup cost K 100
5. Pro Premium & Soft Development K 1800 plus other costs.
Are you willing to sign agreement for this services usage
Please Select
Yes
No
Not Sure
Do you want a gov.pg domain or .com
Note: That .gov.pg will take more then 21 days to be online.
Do you want a TLD with pg. ac.gov. info domain>
Note: That .gov.pg will take more then 14-21 days to be online.
Do you want need add on domain and subdomain
Note: That .gov.pg will take more then 21 days to be online.
File Upload
Browse Files
Drag and drop files here
Choose a file
If you have the service agreement. mou, or non disclosure agreement with you , please upload the file here ( altermatively you can email the file to us on admin@netwebspace.com
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of
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Comment and Questions:
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