ICOM WEB SOLUTIONS HOSTING SOLUTIONS REQUEST FORM
First Name
Last Name
Company
E Mail Address
Confirm E Mail Address
Mailing Address 1
Mailing Address 2
City
State
Zip Code
Phone Number
Fax Number
Cell Number
Do you have a Website Now? If no, skip to next section. Yes   No
If yes, URL?
Amount of Hard Drive Space you currently use
Do you need to increase this space? Yes    No
By How Much?
How many unique hits does your site receive per day?
Do you want to increase traffic to your site? Yes     No
What Multi-Media Files do you have on your site? Video   Audio   Photo Album
Would you like to add streaming videos or audio to your site? Yes     No
Do you need your site redesigned? Yes     No
If you DO NOT have a website...  
Do you have your URL registered? Yes     No
Additional Comments

 
 

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