Backup Express - Signup Form - Online Backup - Offsite Backup - Internet Backup - Data Backup

ICompany Details		Use this form to sign up with Backup Express by filling out all Company , contact details and service required. Select the submit button at the end to forward the form to BackUp Express. All details submitted will be kept for BackUp Express's use only. Refer to our Privacy Policy for additional information.
Company Name:
ABN/ACN:
Contact Name:
Street Address:
City:
State:
Post Code:
Postal Address:
City:
State:
Post Code:
	Same as street address
Phone:
Fax:
* Email:
Optional Email Addresses:
Accounts:
This address will receive a copy of all invoices and receipts.
Technical:
This address will receive a copy of technical notifications and announcements.
* You must enter a valid email address. Your account information will be sent to this address.

Storage Quota		! Help me choose !
Primary Account:
Select	Storage Quota	Cost Per Month(inc GST)
	1 GByte	$29
	2 GBytes	$39
	5 GBytes	$59
	10 GBytes	$89
	25 GBytes	$129
	35 GBytes	$159
	50 GBytes	$199
	75 Gbytes	$249
	100 GBytes	$299
	Additional 50 GByte blocks above 100 GBytes	$50 per 50 Gbytes
Additional Computer Licenses - Click here to see if this is relevant to you
	Additional computer licenses	$5

Secondary Accounts:
For Secondary Accounts please contact our sales team directly.			(for pricing refer to 'multiple account' pricelist)

Preferred User Name
Username: (minimum 6 characters)				Create your own unique User Name to enable access to your account with BackUp Express

Restore Window

Required restore window

1 month

3 months

6 months

Additional Plugins
If required add the optional plugins
	Plug-in for Microsoft Exchange Server ($7.50/month inc GST)
	Plug-in for Microsoft SQL Server ($7.50/month inc GST)

Total Monthly Cost
$	I understand this is the monthly cost (Note: No minimum commitment is required).

Additional Services and Savings
	I will pay annually in advance and receive 12 months for the price of 11 months
Installation Methods:
	Self-install
	Remote install($49 inc GST )

Where did you hear about us?
Please select
Please select your Authorised Dealer
Other (please specify):
Reseller Code:
* You must specify to continue

Promotions:
Please enter your promotional code if you have one:

Other Comments


Billing Information
All new accounts include the first 14 days as a free trial. You may use the service free of charge and with no obligation during that time. Billing will commence automatically 14 days after account activation unless you cancel the account by notice in writing to us prior to that time. Invoices will be sent to you at your nominated email address and are payable in 14 days. Payment may be made via cheque, back transfer or credit card. See 'Payment Methods'.

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