Rent A Server Co-Location Preliminary Application Form

Please enter the following information.
Provide as much detail as possible as this will speed up the processing of your application

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Contact Info
	First Name:
	Last Name:
	Organization:
	Phone Number:
	Email Address:
Organization Information
	Please provide us with a better understanding of what you or your organization are all about
Service Details
	Proposed Usage:
	Server Resources Required:	$149/mth - 25GB - 128MB - 125MHZ $249/mth - 50GB - 256MB - 250MHZ $349/mth - 75GB - 512MB - 500MHZ $599/mth - 100GB - 1024MB - 1000MHZ
	Length of Term:	1 Year 2 Years
	Other Requirements:

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