SecureWebs Account Order Form

Use this form to tell the "new accounts staff" some details about the account you have ordered.  Fill in only the services that are included with your account. 
 

STEP 1:  Tell us who you are. 

Your name:  
Your Address:    
Your City, State, Zip Code:    
Phone Number (with Area Code):
Email Address:
Secondary Email Address:

STEP 2:  Virtual Domain Orders 

Domain Name:
Is this domain already registered? YES NO 
FrontPage Extensions 2002: YES NO   I don't know yet. 
Does this site need DotNet 2.0: YES NO   I don't know yet. 
Do you need a DNS record for your domain? YES NO   I don't know yet. 
Do you need an FTP server? YES NO   I don't know yet.     
Do you need Statistics?
Not included with Stock Account 		YES NO   I don't know yet. 
Do you need mail?  YES NO          (normal mail usage is free)
Do you want our anti-spam solution.  YES NO          (not included free with STOCK ACCOUNT)

Stock and Express accounts  stop here and skip to submit

skip to submit button

STEP 3:  Other Services    

 SQL 2000 or 2005         Database Name:
dbo UserName:
dbo password:
DotNet Version
CHATSPACE SERVER     Version:   3.1 
Name of ChatServer:
User Name:
Password:
Confirmation Email:
WEBBOARD SERVER        WebBoard Name:
Login Name:
Password:
Admin First Name:
Admin Last Name:
Logout URL:
Your Email Address:
Requesting 
FTP Access		 Yes  No       (Used for custom board modification)
 NAMESERVERS      NameServer #1:
NameServer #2:
Where did you hear about us?

 Other comments, questions, multiple domain names or information, such as a phone number to contact you.