E Chiro Solutions - Sign Up Form


	Establish Domain Name if needed Setup website account with 100 MB Setup Unlimited E-mail Accounts Design and upload complete web site with unlimited number of pages Manage all maintenance and updates of your web site (we allow up to 5 monthly changes/updates to your site) Create monthly HTML newsletters to e-mail your patients Create printable forms from your clinic that can be downloaded from your site Provide support for all aspects of your web site & e-mail accounts





	Establish Domain Name if needed Setup website account with 100 MB Setup Unlimited E-mail Accounts Design and upload complete web site with unlimited number of pages Manage all maintenance and updates of your web site (we allow up to 5 monthly changes/updates to your site) Create monthly HTML newsletters to e-mail your patients Create printable forms from your clinic that can be downloaded from your site for new and existing patients Create and manage a shopping cart built into your web site for supplements and other non-service related items your clinic offers Provide support for all aspects of your web site, shopping cart and e-mail accounts

E Chiro Solutions is currently offering a $200.00 discount with all 2-year contracts. With this discount, your up front cost is less than a $100.00!

You can apply this discount to the design fee of either the "Standard Solution" or the "Complete Solution".

To get started, or if you would like more information, please fill out the 3-step form to the right.

If you ready to create or improve your on-line presence, or would just like more information to be sent to you, please complete this 3-step form. This is not a contract, and you're under no obligation by filling out this form. Further information will be both e-mailed and sent standard mail within 48 hours.

Please select the hosting plan you would like, (details of each plan are located to the left.) and length of contract.

The Standard Solution - $299.00 Design Fee + $29.00 Monthly
The Complete Solution - $499.00 Design Fee + $39.00 Monthly

1 year contract
2 year contract - $200.00 Design fee discount applies

Enter the domain name you wish to host with us, and then select one of the options below. (For example, yourdomainname.com)

*www.

I Need A New Domain Name
Select this option if you would like to use a new domain name with your E Chiro Solutions account. We are able to register domains with the following extensions: .com, .net, .org, .biz, .info, and .us.
I Already Have a Domain Name
Select this option if you already have a domain name registered that you'll be using with your E Chiro Solutions account.

Please fill out all your contact information below.

*First Name:
*Last Name:
*Clinic Name:
*Tel Number:
*Email:
*Street:
*Town:
*State:
*Zip code:

* = Required

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