ADAMONGUS

Account Setup Form

First Name:
Last Name:
Business Name:
Email address:
Phone Number (1):
Phone Number (2):
Address (line 1):
Address (line 2):
City:
State:
Zip Code:
Is this your home or business address?

PACKAGE DETAILS
Desired Template (View templates here)
How many pages to your website?:	If more than 15 pages, contact us for estimate.
Your name for your website address: This will be part of the URL
Hosting domain name to use with this account:
Sub Domain or Sub Directory?
Maintenance Plan: (View cost schedule here)
Email Addresses: ( One included, each additional: $1/mo.)

ADMINISTRATIVE
Your Username:
Choose a Password: (5 to 15 characters)
Re-enter Password:
Default Email Address: Other e-mail address will be configured in the Control Panel	@
CODE:
Referred By:
How did you hear about adamongus.com? (If you weren't referred to this site, please let us know how you heard about us.)
I have read and agree to the Terms of Service and Policies Agreement

Thank you for using Adamongus website solutions. Let us know how we can help, or improve our service to you.
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