Hosting / Registrar Form

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Project Coordinator
Domain Registrar Information
1. Where did you purchase your domain? (i.e. GoDaddy, Network Solutions)*
URL: Username: Password:
2. Provide a list of the domain names (URLs) you own:
3. Provide the URL for the MAIN domain name you would like to use:
4. Do you own the assets on your current site? If yes, can you provide admin login access to your FTP/CMS/Wordpress/Joomla backend?
Email Information
1. Is your current email set up on your domain?
For example, do you have email addresses such as doctor@yoururl.com? If not, where is your office email hosted?
2. Do you have an IT/Web Developer contact for your office?
Please provide the name, phone number, and email address for this person.
3. What email address do you want all “Contact Us” forms to be pointed to?

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Domain Registrar Information