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jcline — May 13, 2009 - 12:14pm

Please fill out the form below for us to start setting up your website. We will contact you shortly to verify all information before beginning the creation of your site. Please read the attached service agreement. Submitting this form is considered acceptance of the attached service agreement.

Thank you for your business and we look forward to helping make your site the best it can possibly be.

-- Jelifish Technologies

Site name: *

This is the domain address used for navigating to your site from a web broweser. For example: http:mybusiness.com -- the site name is mybusiness.com

Do you own this domain already?: *

Contact Name: *

Contact Email Address: *

Contact Phone Number: *

Best Time to call: *

Street Address: *

This is the address we will use for sending your invoices to.

City: *

State: *

Zip Code: *

I have read and accept the site service agreement: *

Promotion Code:

If you have a promotion code please enter it here so we are sure to give you your discount.

Referral:

If you were referred to us by another fire department, please let us know who it was so we can properly thank them. All referer's receive half off their next months hosting!

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What is the fourth word in the phrase "ego ive dudi uze idozi"?: *

Attachment	Size
Smallbiz CMS Service Level Agreement	30.82 KB

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