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Website Order Form

Complete as much of the 4 sections below as you can. This will begin the registration process for the set-up and launch of your Internet website.

As soon as you submit this form, you will be directed to the payment page where you can make your initial set-up payment online using your credit card. Upon verification of your information, your initial website account will be activated immediately. Your first monthly payment will not be due until the first month after the actual launch of your website.

Thank you for choosing Data Services of Georgia.


I. About You and Your Business

   Your Name or Contact Person:  
   

   Business/Organization Name:  
   

   Type of Business:  
   

   Description of Business:
   

   Description of Products/Services offered:
   

   Existing E-mail Address:  
   
   Street Address:  
   
   City:  
   
   State:           Zip:         Phone:                      Fax:
                     

   Days and Hours of operation
   (M-F 8am-10pm):
   

   Additional notes or information:
   

II. Website Name / Domain Registration

   II-A. Information for Website Transfer
   (Complete this Section only if you already have an existing website)

    Check here to authorize transfer of your website administration to us.

   What is the domain name of your existing website?
   


   What hosting company currently manages your existing website?
   


   Enter your hosting account login username and password:
   

   II-B. Information for New Website
   (Complete this Section if you do not have a website)

    Desired Website (domain) name
    (such as mysite.com, mysite.org, mysite.info)

    First Choice:
    
    Second Choice:
    
    Third Choice:
    


    Desired Email addresses (me@mysite.com)

    First Address:
    
    Second Address:
    


III. Website Design

   Control Menu location:

   Top of Page
   Left Side
   Both - Top and Left Side
   Other - Please specify:
   


   Background color:

   White
   Other - Please specify:
   



   Text color:

   Black
   Other - Please specify:
   


    Key words for Internet search engines:
   


   Do you want digital photographs on your website?

   Yes - I will send them
   Yes - I need them to be done
   Maybe
   No

IV. Additional Information

   How did you learn about Data Services of Georgia?
   


    Enter any other information we should know:
   





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