NOTE: print out this application form and fill out or write all
required data on blank paper and send to the address noted below.
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POLARHOME.COM ROOT USER'S APPLICATION FORM
Username: _______________________________________
Host: Linux/RedHat [ ] OpenBSD [ ] OpenVMS/Alpha[ ] Minix [ ]
Linux/Debian [ ] FreeBSD [ ] OpenVMS/IA64 [ ] Tru64 [ ]
Linux/SuSE [ ] NetBSD [ ] OpenVMS/VAX [ ] Ultrix [ ]
Linux/Ubuntu [ ] MirOS/BSD[ ] OpenIndiana [ ] IRIX [ ]
Linux/CentOS [ ] DragonFly[ ] Solaris/x86 [ ] QNX [ ]
Linux/Mandriva[ ] GNU/Hurd [ ] Solaris/SPARC[ ] AIX [ ]
RaspberryPi [ ] HPUX/PA [ ] UnixWare [ ] MacOS X [ ]
OpenSTEP [ ] HPUX/IA64[ ] OpenServer [ ]
Age : ______________ Sex: ______________
Real name : ___________________________________
E-mail : ___________________________________
Address : ___________________________________
___________________________________
City/ZIP : ___________________________________
Country : ___________________________________
Project(opt): http://____________________________
Setup and monthly payment by:
Enclosed cash [ ]
Enclosed check [ ]
WesternUnion [ ] MTCN ___________________________
Bank transfer [ ]
PayPal payment [ ] from ___________________________(e-mail)
TransferWise [ ]
Bitcoin payment [ ]
Litecoin payment [ ] TXid ___________________________
IP choice IPv4 [ ] IPv6 [ ]
Please, note some servers support just one (like AIX for example)
By filling out this form, I agree with polarhome.com user policy:
http://www.polarhome.com/service/policy.html and I am aware that:
- I will lose my server account in any case of malicious activity
- personal information above are handled and kept confidentially
- setup and monthly payment fees are paid in advance
- polarhome realm and member hosts provide all services "AS IS"
- polarhome can not guarantee uninterruptible business continuity
- polarhome will refund payments in case of not delivered service
Date ________________ Signature _________________________________
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This form has to be printed, filled, signed and sent by post to:
polarhome.com
c/o arpadffy
Edbovagen 47
14263 Stockholm
Sweden
or alternatively by fax to: +1 772 325 8221 (US efax number) for
faster activation. Scanned images are also accepted, if e-mailed
to support@polarhome.com
General notes:
- text format application forms sent by e-mail are not accepted.
- form has to be filled out personally and signed by hand.
- you should do it JUST if you agree with polarhome users policy.
Please, read FAQ at http://www.polarhome.com/service/policy.html
1. Enclosed cash
- for this method of payment, please use just paper bank notes
2. Enclosed check
- check should be payable to "Zoltan Arpadffy (polarhome.com)"
- note: if the amount is less than 15 USD (the bank realisation
fee per check), then please, use some other payment method -
if you really want to contribute/donate.
3. Western Union money transfer
- the receiver should be: Zoltan Arpadffy - address above.
- please, note the MTCN (Money Transfer Control Number)
- you can find more information at http://www.westernunion.com
4. Bank transfer
- amount should be transferred to:
Zoltan Arpadffy
for polarhome.com
Bank: SEB, Stockholm, Sweden
SWIFT: ESSE SE SS
Account: 5231-0271578
or with another words:
Iban: SE5150000000052310271578
Bic : ESSESESS
5. PayPal payment
- the payment should be sent to sponsor@polarhome.com
- please, note your paypal e-mail address in the form
- you can find more information at http://www.paypal.com
6. TransferWise payment
- the payment should be sent to sponsor@polarhome.com
- please, note your TransferWise e-mail address in the form
- you can find more information at http://www.transferwise.com
7. Bitcoin payment
- send to polarhome wallet: 1Lb6RBuBCaV2r3Q8RBGBZhiA5jDyMTNqrN
- please, note your last five characters of the transaction id
- you can find more information at http://bitcoin.org/
8. Litecoin payment
- send to polarhome wallet: LczkTakPFquCQa5UGbtHRpxd3TxrXQeBPY
- please, note your last five characters of the transaction id
- you can find more information at http://litecoin.org/
If you have any question or suggestion regarding application form
or shell registartion process, you may ask support@polarhome.com
