Web Hosting Service Application Form

Agency Information
Complete Name of Agency

Complete Address of Agency

Telephone Number
Fax Number

Main Technical Contact Person

Name Phone Number

Position/Designation Email Address

Alternate Technical Contact Person # 1

Name Phone Number

Position/Designation Email Address

Alternate Technical Contact Person # 2

Name Phone Number

Position/Designation Email Address

Website Information*
* For agencies applying for hosting of several websites, please replicate Page 3 for the information of each website

Complete Domain Name Computing Platform

Scripting Language Database Platform

Database Size CMS used, if any

Website Information (cont.)

Plugins installed, if any Other server requirements

DNS Hosting

 Hosted at DOST-ASTI  Hosted at a commercial DNS hosting service  Hosted in-house