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Personal Information

(in case we need to contact you)

Your Name
Your Personal Email
Personal Contact Phone
   

Basic Information

(anything entered below will appear on your new website)

Your Business Name
Website Domain Name
Domain Name Information

I own this domain and will point it to your name servers  (info)
I have purchased my domain through DMS WebHost

Name of Template Choice Phoenix
Duluth
Ft. Lauderdale
Chicago
Richmond
Carolina
Savannah
Salt Lake
New York
Atlanta
Memphis
Newark
   

Contact Information

(How your customers will contact you)

Business Owner
Business Address
Suite #
City
State
Zip Code
Time Zone
My Hours of Operation
Business Phone #1
Business Cell Phone #2  
Fax Line
Business Email 1 (info)
Business Email 2
Additional information for my website
   
Hosting Agreement I have read the DataMax Hosting Agreement and agree to be bound by its terms
   
Please do the math   8+4=