Thank you for choosing DeafVision
Please fill in all fields
Domain Name to be Transferred:
www.
.
.com
.net
.org
.biz
.info
.us
Current Hosting Provider:
What is the name of the company that is currently hosting your website? Why have you chosen to switch to DeafVision?
Customer Information -- Main Administrative Contact:
First Name:
Last Name:
Company Name:
Type of Business:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Daytime Phone:
Home Phone:
Fax:
Main Email:
Alternative Email:
Pager:
AOL IM Screenname:
Your Main Computer Platform / OS:
= Choose One =
Mac Classic
Mac OS X
PC / Windows
Unix / Linux
Other
Account Webmaster:
Who will be in charge of this account?
The person you list here will be an authorized contact for your website and will be authorized to contact DeafVision for tech support on behalf of your account.
Name:
Email:
Pager:
AOL IM Screenname:
Webmaster's Computer Platform / OS:
= Choose One =
Mac Classic
Mac OS X
PC / Windows
Unix / Linux
Other
Not Sure
Choose Main Account Login / Password:
Please choose your main user login and password. User login name should be between 6 and 8 characters. Password should 8 characters or more.
For security purposes, a different login/password may be assigned to your account.
User Login:
Password:
Microsoft FrontPage Extensions:
Will you be using Microsoft FrontPage software to design your website?
No
Yes
Special Instructions:
Special Instructions / Comments:
Please tell us...
How'd you hear about DeafVision?
= Choose One =
Referred by a DeafVision Customer
Referred by a Friend
NADMag
Deaf California News
Deaf Aztlan
SIGNews
Newspaper Ad
Flyer
Online Banner Ad
Google
Yahoo
Other Search Engine
Better Business Bureau
Linked to a website I visited
Other
If you were referred by a DeafVision Customer, please include their name and domain below. If they are part of our Referral Program, they'll be rewarded for the referral.
Referred by:
Domain:
Main Reason for Choosing DeafVision:
If you had to choose just one, which of the following was the main deciding factor in your choosing DeafVision as your new web hosting provider:
= Choose One =
Outstanding Reputation
Responsive Tech Support
Reliability/Uptime Guarantee
Ultra Fast Connections
Secure Servers
Features Offered
Flexible Bandwidth
Competitive Pricing
Recommended by a Friend
Deaf/Minority-Owned Business
Money Back Guarantee
Customer Testimonials
Other
Terms of Service Agreement:
By submitting this order form you acknowledge that you have read, understand and agree to be bound to
DeafVision's Terms of Service
and warrant that you are authorized to enter into this Agreement on behalf of your person, organization or business.
Type your full name:
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