Web Hosting Request Form

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Web Hosting Request Form Powered By Docstoc
					                                                Web and Domain Hosting
                                                     Request Form
 Company                                                          Contact

 Contact Email Address

 Address

 City                                            State                                       Zip

 Phone Number (            )


        Registration of Domain Name with Network Solutions
        - One time setup fee of $25.00 to Dakota Central
        - Registration of $59.99 to Network Solutions for two years, (ex. www.yourdomain.com)
Domain Name Requested:
    Check here if you require Front Page Extensions for your website
    Regular Web Package...................................................................... $90(one time setup) ....... $25/Month
     - Web Server Hosting (25MB of space - 1FTP Account), Domain Naming System Hosting
     - 3 virtual e-mail addresses with domain name, (ex. username@yourdomain.com)
     - Outgoing and Incoming E-mail, Real-time Virus Scanning
    Web Server Hosting Only (25MB of Space - 1FTP Account) ....... $45(one time setup)......$10/Month
    Domain Naming System Hosting Only .................................... $35(one time setup) ....... $10/Month
    Email Hosting Only w/domain (ex. username@yourdomain.com)
    3 E-mail Addresses w/domain .................................................... $10(Setup).................... $5/Month
    Each Additional address up to 10 ......................................................................................... $3/Month
    Up to 20 E-mail Addresses w/domain ..................................... $50(Setup).................... $30/Month
    Up to 30 E-mail Addresses w/domain ..................................... $65(Setup).................... $40/Month
    Up to 40 E-mail Addresses w/domain ..................................... $80(Setup).................... $50/Month
    Up to 60 E-mail Addresses w/domain ..................................... $90(Setup)....................$60/Month
    Up to 80 E-mail Addresses w/domain ..................................... $100(Setup) .................$70/Month
    Up to 100 E-mail Addresses w/domain .................................. $110(Setup) .................$80/Month

FTP Account (to maintain web site)                      Login:                               Password:

 Virtual E-mail Addresses and Passwords                                              Setup Information
Email Address:                     Password:                             FTP Access - ftp.yourdomain.com
                                                                              POP3 - mail.yourdomain.com
Email Address:                     Password:                                  SMTP - smtp.yourdomain.com
                                                                           Web Mail - mail.yourdomain.com
Email Address:                     Password:
                                                                     You must Signup for 6 consecutive months

Customer Signature:                                                                       Date            /    /

Authorized Agent:                                                                         Date            /    /

				
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Description: Web Hosting Request Form