P.O. BOX 8345, RUSTENBURG, 0300
           TEL: 0861101847 (+27) 145920815
           FAX: (+27) 0865040836
           CELL: (+27) 0839559937
Please complete this form, sign it and fax it back to 0865040836or email to (Select from each box an option)
    MARK          Period                  Description of service ordered             PRICE            Total
                              REGISTRATION OF DOMAINS-extensions                   Excl of VAT

                YEARLY        Domain Registration (transfer is free)         R90

                YEARLY        .ZA.NET / .ORG.ZA (With NPO number)                  R57

                YEARLY        .COM / .NET / .INFO / .ORG / .MOBI / .COM.NA         R250
                YEARLY        .TV                                                  R741

                2 YEARLY       .CO.UK /                                            R627
                              HOSTING PACKAGES

      1.        Yearly                                                             R 750 p/y
                               Excludes support / Domain renewal

      2.        Monthly                                                            R5500 p/m
                              DEDICATED HOSTING:
                Once Off      Setup of control panel                               R2950
                Once off      Trainers: Train The Trainer Program                  R15000
                              WEBSITE DESIGNING OPTIONS
FULL WEBSITE    Per Hour                                                           R900
                              Design of websites in PHP, HTML, WEB2,
WITH CMS AND    Per Day                                                            R5000
                              WARP5, CMS, Shopping CARTS, CRM, etc.
                Deposit       Deposit required prior to web design                 R2500
                              Travelling (Choose only if more than 50km from
 TRAVELLING     PER KM                                                             R3.50
   IMPICMS      PER ITEM      Extensions or module installations in ImpiCMS        R350
   IMPICART     PER ITEM      Extensions or module installations in ImpiCart       R900
  TEMPLATES     PER ITEM      Travelling (more than 50km from Rustenburg)          R3.50
                              ADSL SERVICES (More options available online)

                              ADSL Username and Password per/Gig
ADSL ACCOUNT                                                                       R150
                              ADSL Line Rental Up to 384 kbps line speed
   NEW OR       Monthly
 TRANSFERS                    ADSL Line Rental Up to 512 kbps line speed           R300
                              ADSL Line Rental Up to 4096 kbps / 10016 kbps        R400
                Prepaid       Prepaid ADSL Username and Password                   R69 P/Gig
                Deposit       Deposit required on prepaid accounts                 R300

    ADSL        Monthly       ADSL Username and Password per/Gig
                                           Live on Page Rate Card
                                    You write your own script              We help you write the script
                                    You host on your own server            We stream from CDN
                                    Basic actor/talent choice              Top tier acting choice
                                                                           R1800 for reshoots
                                                                           Performance guarantee

                                                           LIVE ON PAGE (SOUTH AFRICA)       Page 2
                         P.O. BOX 8345 RUSTENBURG 0300 TEL: 0861101847 FAX: 0865040836
                                                                                    Monthly reporting
                                                                                    Secure Socket available
                                                                                    Celebrities for hire

    Per video           Once Off      0-30 seconds                                             R3950
    Per video           Once Off      30-60 seconds                                            R4950
    Per video           Once Off      60-90 seconds                                            R5950
                                   No monthly streaming cost is charged when you host the HD video on your site.
Stream with a Content Delivery Network (RECOMMENDED)
    Per video           Once Off      0-30 seconds (4 videos and more)                         R2500
    Per video           Once Off      30-60 seconds                                            R3500
    Per video           Once Off      60-90 seconds                                            R4800
Streaming fees
     1st Video          Monthly       Streaming cost includes unlimited hits                   R450
     2        Video     Monthly       When using one to three videos the cost is               R390
     3        Video     Monthly       Added together i.e. 3 videos = R1140                     R300
                                      After the 10 Video the streaming fees is
 4th to 10th Video      Monthly                                                                R1200
                                      repeated from one.
               Host on your site                             CDN Hosting
Talent Upgrade = R2800                      VIP Required Talent = R2800
Script Phone Consult = R1500                Script Phone Consult = R750
Secure Socket Setup = R500                  CDN is secured

Instructions: You should keep in mind that you must have a domain name                         TOTAL
reserved to be able to create a hosting account.                                               MONTHLY

                                                  APPLICATION FORM
                                                  APPLICATION FORM

Please fax the following documentation with this debit order form instruction:
Business or company registration documents
Identity or passport document
Proof of address as per FICA regulations
Resolution in case of company or CC that the signatory has the right to apply and to instruct this debit order form
Cancelled cheque or bank letter to proof the existence of the account.

                                                                 LIVE ON PAGE (SOUTH AFRICA)             Page 3
                               P.O. BOX 8345 RUSTENBURG 0300 TEL: 0861101847 FAX: 0865040836
2. Particulars of person responsible for the debit order instruction:
Full names
Surname / Family name
Business Name
Postal box number
Cell phone number
Landline number
Fax number
Vat Number
Identity number / passport number
Registered name of domain:                              http://www.                                   Extension:
Registered name of ADSL                                                                             @ImpiConnect
Debit order:                                            3. YOUR BANKING DETAILS: OUR BANK DETAILS
Bank name                                                                                 FIRST NATIONAL BANK
Branch name / Town                                                                        Rustenburg Square
Branch number                                                                             202009
Account name                                                                              Live on Page (South Africa)
Account number                                                                            62284017970
Type of account                                                                           CURRENT
I/we hereby request and authorize you to draw against my/our account with the above mentioned bank (or any other
bank or branch to which I/we may transfer my/our account) the sum stated on this order form or any variable amount
pertaining to this agreement, on or before the first working day of each and every month. This being the amount
necessary for the payment of the monthly payment or premium due to you in respect of this purchases / contract /
agreement signed and dated in this document. I understand that it is still m duty to ensure that payments are done in
the event that a debit order is not launched on my account before the 3 rd of every month and ongoing. All such
withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us personally.
I/we the undersigned "instruct" and authorize your agent Netcash (Pty) Ltd, or any authorized financial provider to draw
against my/our account with the abovementioned bank, I/we understand that the withdrawals authorized here will be
processed by BankServ and I/we also understand that details of each withdrawal will be printed on my/our bank
statement. I/we agree to pay any bank charges relating to this debit order instruction and will also be liable for the cost
of debit orders not has been honored, stop, misleading bank information or lack of notice at a rate of R385.00 per order.
This authority may be cancelled by means of giving you sixty days (60) notice in writing, sent by prepaid registered post,
but I/we understand that I/we shall not be entitled to any refund of amounts, which you have withdrawn whilst this
authority was in force if such amounts were legally owing to you.
I/We acknowledge that the party hereby authorized to effect the drawing(s) against my/our account may not cede or
assign any of its rights and that I/we may not delegate any of my/our obligations in terms of this contract/authority to
any third party without prior written consent of the authorized party.
I, the applicant agree that I will be listed to a credit bureau by Live on Page in the event that the conditions set out in
this document together with the conditions as displayed on the website of Live on Page at the address: and I have read and understand the contents of this document and accept
all the terms and conditions set out in this document and understand that this document terms and conditions changes
are published on the website of Live on Page from time to time and I will aquiant myself with these changes on a
timeous basis.
Signed at _____________________ on the ________ day of ___________________ 2011

In the presence of the undersigned witnesses.
_____________________                                           _____________________________
WITNESS NAME                                                          WITNESS SIGNATURE

                                                               LIVE ON PAGE (SOUTH AFRICA)               Page 4
                             P.O. BOX 8345 RUSTENBURG 0300 TEL: 0861101847 FAX: 0865040836

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