Debit Order Authorisation

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DOMAIN REGISTRATION AND DEBIT ORDER AUTHORIZATION

In order to register your new internet domain, kindly make use of the form below. Please also ensure that you agree to the following:

  • Domain registrations and hosting is available via debit order only. No cash or credit card payments will be accepted.
  • Domains registered via Internet Namibia may not be cancelled within 6 months from registration. After this initial period, a notice of one calendar month may be given in writing in order to cancel your domain.
  • The first debit order will include the initial registration amount of N$130.00 as applicable for the Micro Pro and Basic packages. Consequently clients can expect an initial debit order slightly higher in the first month only. Thereafter the normal hosting fees depending on your hosting package will apply.
  • Clients who opted to accept a Website Starter Package and pay for it via debit order over six months, will see a different amount deducted during the first six months. Thereafter the normal hosting fees will apply.

Now... let's get started!
What is your choice of hosting package? *

 

Client Details
First Name *
Last Name *
ID Number *
Copy of your ID *
Company
Postal Address *
City *
Email Address *
Celphone Number *

Banking Details

Account Holder (Full Name) *
Bank *
Branch *
Branch Code *
Account Number *
Account Type *
Confirm Debit Order Date *

Domain Details

In the section below, please provide us with some choices as to what domain names you have in mind. Remember that a domain name must be unique right throughout the world. For example: www.mycompanynamibia.com or www.windhoekrestaurant.com.
Option #1 *
Option #2 *
Option #3
Option #4
Option #5

Debit Order Authorization

Declaration

  1. I confirm that that bank account that I have provided is a valid account and that I have complete authority to instruct Internet Namibia Services CC to process debit orders against this account.
  2. I understand that the withdrawal(s) as specified above will be debited through the ACB Magnetic Tape System and I understand that my bank statement(s) will reflect the transaction as such.
  3. I undertake that I will settle all relevant bank costs with regard to this transaction.
  4. I understand that this authorisation may be cancelled by me/us by giving Internet Namibia Services CC one calendar month's written notice.
  5. I understand that I will not be entitled to any refund of fees processed by Internet Namibia Services CC for collection before the cancellation request is received by Internet Namibia Services CC.
  6. I understand that this standing order will be renewed every year until cancelled by myself and that the amount debited from my account may vary subject to the changes in Internet Namibia Services CC fees.
  7. I understand that this debit order authorisation is for monthly debit orders and that the amounts debited may vary in the first six months, depending on whether additional services were contracted from Internet Namibia Services CC.
  8. I will make sure that there are enough funds available in this bank account on the set date mentioned in point 12 below.
  9. I understand that in the unfortunate event of a rejected transaction, Internet Namibia Services CC will automatically present the rejected amounts the following month in addition to amount due for that month. This will then be considered a double debit. In addition Internet Namibia Services CC may, in its discretion, debit my account with a service fee every time a transaction is rejected.
  10. I understand that in the case of three unsuccessful debit orders in a row, Internet Namibia Services CC reserves the right to cancel my debit order arrangement.
  11. In such an event, I understand that myself, as proxy for my company, and my company may be jointly and severally held liable for any outstanding costs.
  12. I hereby authorise Internet Namibia Services CC to debit my bank account on the date selected above every month.
I hereby agree to the above and authorize debit deductions from my stated bank account *

Electronic Signature Agreement

  • By selecting the ‘submit’ button, you agree that your electronic signature is the legally binding equivalent to your handwritten signature on this debit order instruction.
  • You agree that we don’t have to validate the authorisation you have given with any third party as you have the full legal right to authorise this debit order instruction.
  • You understand that your electronic signature enforces a contractual agreement between you and Internet Namibia Services CC.
  • You confirm that you have authorised all persons who may log into your member profile on your behalf to authorise this debit order instruction.
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