Web Hosting Order Form

Please fill out the information below to start setting up your website as quickly as possible. Your website should be available within 48 hours of confirmation. At a minimum, we will need your contact information, so we can call you for billing information and any additional information needed for the website.

Customer Information
 
Contact Name
Company Name
Address
City
State
Zip Code
Phone Number
Fax Number
Email Address

Domain Names
 
Provide a list of possible domain names you would like below (e.g., "YourCompanyName.com"), in order from most to least preferred. We cannot guarantee that any particular domain name will be available. When we contact you to confirm the order, we will inform you which, if any, of these domain names are available. You only need to provide one domain name below, but additional ones are recommended.

The web hosting special includes one domain name. If you would like additional domain names to go to the same site, it costs $24 / year for each domain name.

Number of Domain Names
Domain Name 1
Domain Name 2
Domain Name 3
Domain Name 4
Domain Name 5

Email Addresses
 
The web hosting plan includes 5 email addresses. Additional email addresses are available on request. Please provide the mailbox names you would like below (e.g., if you would like the address "myemail@ourbiz.com", type "myemail").

Mailbox 1
Mailbox 2
Mailbox 3
Mailbox 4
Mailbox 5

Email Aliases
 
In addition to email addresses, the web hosting plan includes unlimited email aliases. An email alias is a "fake" email account, such as myalias@ourbiz.com, that simply forwards any email it receives to another address. If you would like email aliases, please provide the alias name (e.g., "myalias" in "myalias@ourbix.com") and the destination email address below.

Alias 1 Forwards to
Alias 2 Forwards to
Alias 3 Forwards to
Alias 4 Forwards to
Alias 5 Forwards to
Alias 6 Forwards to
Alias 7 Forwards to
Alias 8 Forwards to
Alias 9 Forwards to
Alias 10 Forwards to

Additional Information
 
Included with the web hosting plan is a simple starter page for your website, which includes your logo, some introductory text, and up to three images.

Include a Start Page? Yes No
Questions / Comments
Please send me information on your programming services (for e-commerce websites and custom web forms)
Please send me information on your dial-up Internet connection services
Please send me information on your broadband Internet connection services for businesses

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