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Hosting Details
Select preferred Plan	Select Plan Email $199.50 Basic $199.50 Business $259.50 Enhanced $399.50 Premium $499.50 *
Your domain name	*
Your Email	*
Preferred Username
NOTE:	1. Your user name and password will be emailed to the email given. 2. A domain name is required for hosting with CQ4 Hosting Pty Ltd.
Accounting Details
Title	select title Mr Mrs Ms Miss Dr
First Name	*
Last Name	*
Address 1	*
Address 2
City	*
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Post Code	*
Country	*
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* I have read CQ4 Hosting Pty Ltd Privacy Statement.
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On-line payments are made using the PayPal secure payments server. We accept Visacard and Mastercard and of course you can use your PayPal account.

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