Web Site Development -- Ecommerce Solutions - Content Management Solutions

Phone: 610-828-5221

Hosting Solutions

Hosting Plans

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Web Hosting Order Form

Hosting Package:

Administrative Contact


Responsible for administration of the web hosting account.
*Name:
Organization name:
*Street address:
*City:
*State:
*Zip code:
*Phone:
Fax:
*Email address:
Referred By:

Billing

This contact will be responsible for billing of the account. Same as administrative contact
Name:
Organization name:
Street address:
City:
State:
Zip code:
Phone:
Fax:
Email address:

Domain Information

Domain name for site: www.
	I would like to receive:
		Assistance on registering this domain name.
		Assistance on modifying this domain name's existing registration information.
		I already have this domain name. Please provide me with Rome Technology's DNS information only please.
		I will register this domain name on my own. Please provide me with Rome Technology's DNS information only please.

Hosting Options

	Where would you like your configuration e-mailed?: This is the address that will receive your initial account set-up instructions. You will be able to modify your mail accounts after the setup process.

555 Andorra Glen Court, Suite 11
Lafayette, PA 19444
Phone: 610-828-5221
Fax: 610-313-9896