Service Provisioning Form

Service Provisioning

Please skip any questions you're unsure of. If we need any additional info, a tech will be in contact soon to ensure prompt delivery of your service.

Name
Email
TechSurgeons Services Purchased
- Website Hosting
- Website Design
- Website Assistance
- Remote Technical Support
Choose services purchased.
Website Hosting
Questions related to Website Hosting.
Domain names, email addresses, type of setup required (new or transfer).
Hosting Type
- New Website
- Transfer Existing Website
Website Primary Domain Name

Your website's primary domain name.
i.e. techsurgeons.com
Additional Domain names

Any additional domains you want linked to your website.
i.e. <firstlast>.com points to <lastfirst>.com
May require additional purchase
Email Forwarding

This list is for email addresses you'd like forwarded.
i.e. contact@<example>.com to name@hotmail.com
Email Accounts

This list is for email accounts you'd like created.
i.e. yourname@<example>.com
Current Web Hosting Info
Please enter info about existing hosting setup. For example the web host's name, service expiration date, & a list of any email accounts you have with them.
Please don't include any passwords here.
We will contact you directly to schedule your move.
Webite Design
Questions to get us started on your website's new design.
Site Title

Your Site Title is what's displayed in your web browser's tab info.
Site Tagline

In a few words, explain what this site is about.
Header Image
Accepted file types: jpg, gif, png, pdf, Max. file size: 1 GB.
If you have a header image in mind for your site, upload it here.
We may need to crop the image to match your site's theme.
For your protection, please ensure you have the right to use all images.
Background Image
Accepted file types: jpg, gif, png, pdf, Max. file size: 1 GB.
If you have a background image in mind for your site, upload it here.
For your protection, please ensure you have the right to use all images.
Social Media Accounts to be Listed

Please list each social media site you want highlighted on your site.
Page Names

Please list your preferred page names.
i.e. Home, Books, Blog, About, and Contact
Preliminary Text
If you have any preliminary text for your pages, paste it here. We will show you how to edit and update new text.
Website Assistance
Questions to help us fix your website.
Describe the Website Gremlins
Tell us what's broken or what features you'd like us to add.
Who hosts your website?
- TechSurgeons
- Some other hosting company
Other Hosting Company

Other Hosting Company Name
Preferred Day for Website Work
MM slash DD slash YYYY

When is your preferred day for us to work on your site?
Other Scheduling Info
Other info on website assistance.
For example, alternate dates and times for website work, your blog schedule, or any other info for scheduling purposes.
Remote Technical Support
Questions relating to us remotely connecting to a virused or otherwise malfunctioning computer.
Requires somewhat working Internet connection, web browser, and Java plugin installed.
Problem Description
In as much detail as you can, describe the computer's behavior.
Preferred Service Date
MM slash DD slash YYYY

Preferred date of remote service call. Please specify your timezone in the notes field.
Preferred Service Time

: Hours

Minutes

AM/PM

Preferred time of remote service call. Please specify your timezone in the notes field.
Additional scheduling info
Please put your timezone info and include alternative good times/dates for service.
Data Usage Policy

Info provided on this form will only be used for its specific purpose. It won't be sold, whipped, or chopped.
Name
This field is for validation purposes and should be left unchanged.

Service Provisioning Form

Service Provisioning

Website Hosting

Webite Design

Website Assistance

Remote Technical Support

Customer Services