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Hosting Intake

Hosting Intake

Let’s Gather Up Some Detail.

Hosting Intake Information

This is an Intake form we use to gather the necessary information for domain, email, and/or website hosting. Please complete whatever information you have available.
Contact Information
For*
- Individual
- Company or Organization
Company Name
Full legal name of business or organization
Primary Contact Name*
First Last
Email*
Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Additional Contacts for
- Billing
- Technical / Developer
- Alternate
Enter additional contact information, if different from above.
Billing Contact
First Last
Billing Email
Billing Phone
Billing Address
- Same as Primary Address Above
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Technical / Developer Contact
First Last
This person will be authorized to request changes to your services or data being hosted.
Role (Technical, Developer, Other)
Technical Contact Email
Technical Contact Phone
Technical Contact Address
- Use Primary Contact Address Above
Technical/Developer Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Alternate Contact
First Last
This person will be authorized to request changes to your services or data being hosted.
Alternate Contact Role
Alternate Contact Email
Alternate Contact Phone
Alternate Contact Address
- Same as Primary Address Above
Alternate Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Hosting Services
Domain Name
This domain is to be*
- Registered (New)
- Transferred (Existing)
- No Action (Registered, Transfer not Required)
Domain is registered at
(Leave blank if you don't know)
Domain Registrar Website / Login Page

(if you know it)
Domain Registar Login
Login name or associated email, if you know it (This one is important, but we can get it later if you don't have it handy.)
Domain Registrar Password
If you know it; if not, it can likely be reset.
Additional Domains?
- Yes
Additional Domains
Domain Name New or Existing? Used for

Indicate for each domain whether it is new (to be registered) or has already been registered (to be transferred). Please indicate the use for any domain which requires configuration: e.g., email, secondary pointer to website, separate website, future use, etc. (we can also work these out later)
Website Migration or Setup
- Migrate Existing Website
- New Website Build by Developer
- New Site, Install WordPress for Me
- Domain Only for Now
Current Website Host
- Same as Domain Above
- Other
- I Don't Know
Current Web Host
Control Panel Login Page
Current Host Login
Login name or associated email, if you know it (This one is important, but we can get it later if you don't have it handy.)
Current Host Password
If you know it; if not, it can likely be reset.
Website Platform
- WordPress
- Joomla!
- Drupal
- Other Content Management System (Has Admin Login)
- No Content Management System
- I Don't Know
Website Platform
If known; e.g., Expression Engine, Magento, Moodle, custom.
Website Admin Login
Name or Associated Email Address for your Website CMS, if known.
Website Admin Password
(If known)
Email Hosting
- None
- Create New Addresses
- Migrate Existing Addresses
- Leave Email Where Hosted
Email will remain
- On Office365
- On Google (Hosted Gmail)
- Hosted by Third Party
- Hosted Internally
Emails to be Created

List each new email address (inbox) you need.
Emails to be Migrated
Email Address Password

List each address to be moved, with passwords if you have them.
Do you need email aliases?
- Yes
An email alias is a "pointer" to another email address, and does not have its own inbox. For example, billing@yourdomain.com can point to sally@yourdomain.com, or sales@yourdomain.com might point to both joe@yourdomain.com and bill@yourdomain.com. You can also point to external addresses, such as you@yourdomain.com pointing to you@gmail.com
Email Aliases to be Created
Email Alias Target Address

List each alias with the corresponding target, or "forward to" address.
Managed Hosting Plan
Managed Hosting Plan
Site Care Hosting Plans include free inbound site migration with no setup fee.
Total
$ 0.00 CAD
Amount of payment to be processed
Make Payment via
- Credit Card
- Interac
- PayPal
Credit Card

Card Details

Cardholder Name
You can send Interac payments to accounts@100percenthelpdesk.com and we will complete your Site Care Hosting setup once your payment is received.

Use your own financial institution’s online banking by following their Interac e-transfer procedure: learn more about Interac e-transfer.
After submitting this form, you will be directed to a PayPal login page to complete the payment.
Final Notes
Add Special Notes or Instructions?
- Yes
Did we cover everything?
Special Notes or Instructions
Consent*
I accept the agreements listed below.
I agree to 100 Percent Helpdesk Ltd.'s Privacy Policy, Standard Terms & Conditions, and Acceptable Use Policy. I authorize 100 Percent Helpdesk Ltd. to register or transfer domains for me, and agree that if 100 Percent Helpdesk Ltd. consents on my behalf to a third party's terms and conditions for domain registration, I will be bound by those terms and conditions as if I had provided my direct consent in each case.
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Questions About What We Need to Start?

Name*
First Last
Phone*
Email*
Contact*
Message*
Comments
This field is for validation purposes and should be left unchanged.

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Printed on February 24, 2020 from 100percenthelpdesk.com/hosting-intake/?plan=extended