Fill out the following Personal Information (all is required):

Name     
Company  
E-mail   
Work Tel 
FAX       
Home Tel 

Address (required):  Home Address  Company Address

Street Address 1:
Street Address 2:
City:  State:  Zip Code:  

Fill out the following information about your Web Site Below:

Type of Web Site

Business Personal Retail Organization (Other) Other:

 

Please Describe the Purpose of your Web Site:

 

Choose a User Name for your Web Site (One word, 12 characters or less. It is case sensitive):

 

Choose a Password for your Web Site (leave blank if you would like us to choose one for you.  Avoid words or initials; mix cases and characters for maximum security and use at least 6 characters. Passwords are case-sensitive):

 

Do you want a unique Domain Name? (add $75)  Yes No

If Yes, choose three Domain Names.  If No choose three Web Names.  Keep them short (price does not include registering your domain name with InterNIC, which currently costs $70 for 2 years. Check Domain Name availability here).
(Domain name: www.your_name.com  |  Web Name: www.clevenet.org/your_name)
Domain/Web Name1 
Domain/Web Name2 
Domain/Web Name3 

The Following are for those with, or wanting, a Domain Name:

Is your domain name already Registered with InterNIC?  Yes   No

If not, do you want us to register your Domain Name for you?  Yes   No

 

Are five Megabytes of storage sufficient for your Web Site?  Yes No

If not, how many extra megabytes do you need? (add $5/yr per each 2 meg over 5):

Do you currently have an ISP? Yes No  (Note: we are not a general ISP and do not provide dial-up access at this time.  You need dial-up access to publish and maintain your web site.  AOL can be used for this purpose)

Do you want us to build your initial Web Site? (add $75)  Yes No

Do you want us to submit your site to the major search engines? (add $25) Yes No

Do you want a CleveNet Directory Listing? (free): Yes No

If so, list what categories your business/products belong under:
List key words associated with your products/services:

Before Submitting, read the statement below and check the box.   Also, please submit a complete payment to the address at the bottom of the page.   We will send you an e-mail asking for a confirmation of this information. Please reply promptly.  Your web site will be set up as soon as your payment is received.

Waiver: By checking this box, I waive all rights against Bodi & Associates for any harm resulting from my use of Bodi & Associates computer services to set up this Web Site, and I agree to make all agreed payments for these services.  By checking this box, I profess that I understand and assent to these terms.

Check here if you want to be contacted as soon as possible for help!