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Company Information

Company Name:

Address 1*:

Address 2:

City*:

State*:

Zip Code*:

Country*:

Domain Name*:

		This domain name has not yet been registered.
		This domain name is registered and I currently have website hosting service with this domain name with another company. You may point my domain name to my hosting account immediately. I plan on moving it to my new hosting account with Hostirian immediately. By choosing this option, I am giving Hostirian permission to move this domain name to my new Hostirian website hosting account.
		This domain name is registered and I currently have website hosting service with this domain name with another company. I plan on moving it to my new hosting account with Hostirian only after I know it is working perfectly on my Hostirian hosting account. I will contact Hostirian when I am ready to have my domain name pointed to my Hostirian hosting account. Until you instruct Hostirian to move this domain name you will have to access your Hostirian website hosting account via an IP address. Email will not function for this account until the domain name is moved.

Contact Information

First Name*:

Last Name*:

E-Mail:

Phone*:

Fax:

Username & Password

Requested Username*:

Requested Password*:

FrontPage Ext.

No
Yes

Service

IIS Basic
IIS Basic Plus
IIS Advanced
Apache Basic
Apache Basic Plus
Apache Advanced
IIS CF Basic
IIS CF Advanced

If you selected IIS Advanced, Apache Advanced and/or IIS CF Advanced, please complete the follwoing:

Database Name:

Database Username:

Database Password:

(800) 654-0023