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Step 1:

 Customer Details:
Contact Person: **ID No.:
Work Phone No.: Home Phone No.:
Fax No.: Cell No.:
Physical Address: Postal Address:
Physical Code: Postal Code:
Email Address:    
Employer Name: Occupation:
Employer Address: Postal Code:
 Services Required:
Internet Connectivity: Hosting:
Email Hosting: Fax to Email / Email to Fax:
Domain Registration: Bulk SMS's: