· S Y N C R O N I C I T Y - Registration Form

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NEW ACCOUNT REGISTRATION

303.256.4657

CONTACT & BILLING INFORMATION

Name:
Company or Organization:	City:	State:
Address:	Zip:
E-mail Address *: (required):	Ph:	Fax:

SELECT A HOSTING PLAN

Select the type of web hosting service you wish to activate.
501c3 Non-profit status will need to be verified in order to receive annual pre-pay prices.

SELECT A BILLING CYCLE

Select a payment schedule that works best for you.
501c3 discount pricing requires annual pre-payment.

PREFERRED METHOD OF PAYMENT

Please mail checks to:
SYNCRONICITY.NET
Attn: New Accounts
12057 West 75th Lane
Arvada CO 80005

Card #: | Exp. Date:
Name on card: | Zip Code where billed to:
3/4 digit security code (on back of card):

DOMAIN NAMES

Do you have an existing domain name?
If YES, ENTER YOUR CURRENT DOMAIN NAME:
If NO, ENTER THE DOMAIN NAME YOU WANT TO REGISTER:

Use the space below to request additional domain names:

WEB SITE FEATURES

Please indicate the features you wish to have enabled for your website. Only check the ones which are applicable to the plan you signed up for. If you are uncertain, please call us at 303.256.4657

Microsoft FrontPage 2002 Extensions
PHP4 Extensions
mySQL Database
ASP/.NET
SiteStudio
Web Stats
Password Protected Directory
Secure SSL Certificate
Form-mail Scripts
I'm not really sure, please contact me
I'd like some help with my web site design

Use this space to request any additional special services:

mySQL, Access & MS SQL Server Database Customers:
Use the space below to indicate if you have a preference for the data source / database name(s) you need set up. If unsure, contact your webmaster contact our help desk at 303-256-4657.

E-MAIL SERVICES

I need e-mail services for my domain? Yes No
If YES, please use this space below to provide staff names and their preferred e-mail addresses and we'll set everything up for you (absolutely free).

Be sure to indicate whether any of the addresses should be set up as forwarding accounts (to AOL, MSN, Yahoo or HotMail, etc..)

OPTIONS, UPGRADES & ADD-ONS

MXLogic Spam & Virus Filtering Services
Cold Fusion MX
ODBC
Access 97/03
Microsoft SQL Server Database
JSP/Tomcat Servlets
SSL Certificate
e-Marketing Management Software
Other (specify):

GENERAL INFO

Once your account is activated, how do you prefer to be notified?
Which industry best describes the nature of your business?
How did you first learn about SYNCRONICITY?
Why did you choose SYNCRONICITY as your web hosting provider?
Do you have any additional comments?

I have read, understand and agree to the service agreement for SYNCRONICITY services. By submitting this request, I certify that I have been authorized to request services on behalf of my company or my client and that I am responsible for complying with the terms of this agreement. If not, your request for service can not be processed. Please contact us for assistance and/or clarification.