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Step 1: Data Pelanggan/Customer Data
   
Full Name:* Referensi ID:
Place & Date of Birth:* E-mail:*
  (yyyy-mm-dd)
Address:* City:
Province:
Country:
Phone:* Fax:
Handphone: ID. Card Number:
   
Step 2: Keanggotaan Perusahaan/Company Membership
   
Company Name:* NPWP/Akte/SIUP:*
Billing Address:* City:
Province:
Country:
Phone:* Fax:
E-mail:*  
 
   
Jenis Layanan/Services
   
Services:* Packages:*
   
Nama Domain/Domain Name Services
   
Status:* Domain Name:*
New Register  Renewal  Transfer
www.
Term:*  
1 Year3 Year5 Year10 Year 
   
Pilihan ID & Password CPanel Hosting/ID & Password Choice Hosting CPanel
   
1st Choice:* 2nd Choice:*
Password:*  
 
   
Pilihan ID & Password E-mail/ID & Password Choice E-mail
   
First Email:* Password 1:*
Second Email:* Password 2:*
   
Pembayaran/Method Of Payment
Tunai/Cash  Giro  Transfer  ATM BCA  Klik BCA
Kode Keamanan/Security Code
Pernyataan/Statement
I hereby confirm that the information here in give is correct and agree to be bound by all terms, condition and policy
Yes, I Agree
Domain Checker

Contact Information
Jl. Perak Timur No. 62
Surabaya 60164
Jawa Timur-Indonesia
Phone: +62-31-355 0967
Fax: +62-31-353 7566
Email: info@solindohost.com

Marketing
David Sutanto
Jakarta
-Indonesia
Phone: 0815 1308 3333
Email: david@solindohost.com
CS 01
CS 02
Server Admin

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