IMPORTANT: If you qualify for our ‘3 months free’ special as a new start-up package customer we will need to take your credit card info before we can begin working on your website. Please call Glace in the website department at 1-888-768-6822 ext100 with this info. We will use this info to charge you the day after your 3 months free trial has ended unless you contact us ahead of time to opt out and cancel your website hosting with us.

Your First Name

Your Last Name

Your Business Name

Your Business Phone Number (for customers to contact you at)

Your Email

First City you Service

Second City you Service

Third City you Service

Fourth City you Service

Fifth City you Service

Already have a Domain Name Registered?
yes no 

Desired Domain Name:

What colors would you like on your website? (Check 1 or 2 boxes or just leave this blank and we will pick)

 red blue yellow green orange purple grey silver gold white

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