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Order Form

If you're ready to have your site hosted by Bergey.net, please complete the form below with as much information as possible, and we will get back to you shortly (usually by e-mail) to confirm everything and to make payment arrangements.


Your name:

Your company:

Your e-mail address:

Your telephone number:

Your mailing address:

Domain name of the site you'd like hosted (if known):

Have you already registered the domain name?
Yes, already registered
No, not yet registered

Is this a new site or is it hosted elsewhere currently?
New site, not currently online
Already online but hosted elsewhere

Hosting plan you'd prefer:
Basic Plan ($19/month)
Standard Plan ($29/month)
Advanced Plan ($39/month)
I'm not sure.

Please include any additional information or questions you have in this message area:


If you have any problems with the form, e-mail Bob Bergey at bob@bergey.net, or phone Bob directly at 215-723-0777.

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