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Standard Account

Non-Domain Request Form

Fill out the form below, to sign up for our Standard Non-Domain hosting services
After you are done select "Send Info".

All fields must be filled in.

Your Name:

Address:
City:State:     Zip Code:
      
E-Mail Address:
(Enter "None" if you don't have one.)

Day Time Phone Number:
(Don't forget the Area code)

Briefly explain your web site:

Enter "None" on the next three lines, if this is a person web site.
Company Name:

E-Mail Address:
(Enter "None" if you don't have one.)

Day Time Phone Number:
(Don't forget the Area code)

The name you want for your directory:
(Example, www.bronson-tate.net/your-name)

Hard drive space required:
For billing reasons.
If more space is required in the future, it is available upon request.

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E-Mail Aliases:
(Example, your-name@bronson-tate.net)
Leave any or all blank if you don't want E-Mail Aliases

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Please place additional instructions in the box below.
(The box will expand as necessary)

I have read and understand the "Terms and Conditions"
set forth by Bronson-tate.net.
I agree to abide by them.

Yes, I Agree  

No, I Disagree  

	
         


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