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Database Signup

Customer Address
Name:  
Company (optional):  
Address:  
Address (cont.):  
City, State, Zip:    
Telephone:   () -
Fax:   () -
E-mail:  
Bill to this address?   Yes   No
DCANet Customer ID:
(existing customers only)  
Billing Address (If different than above)
Name:  
Company (optional):  
Address:  
Address (cont.):  
City, State, Zip:    
Telephone:   () -
Fax:   () -
Database Information
Available Databases:
  • PostgreSQL Database: PostgreSQL database for UNIX website - $5.00/month
  • MySQL Database: MySQL database for UNIX website - $5.00/month
Select Database Type:  
Website Name
(domain name of associated website):
Database Password:  
Retype Password:  
Please enter any additional comments below:
  

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