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Empowerment through collective innovation

Service Request Form

Important Please fill out this form and we'll get back to you as soon as possible. Be aware that if you order a hosting account, we will create the account and send a bill to your address automatically.
Administrative Contact

Identification of the Contracting Party.

The username you would like to have for your Koumbit account, or the one already set up while opening a previous account. This username should have at least 4 and at most 16 characters, and should contain only non-accented characters, numbers, dashes (-) and underscores (_).

Hosting Services

Hosting service you are interested in.

Other services you may be interested in. If the service you need is not in this list, please fill the "Other Info" section below.

I agree with Koumbit's Founding Principles, and I understand that a $10 membership fee ($30 for moral persons) will be added to my invoice. For more information see http://membres.koumbit.org/en/become_a_member

Enter your full postal address and, if needed, the name of your organization's accountant.