|
Mouse over all boxes
& correct any errors. Then Press "Submit Form" Button to send. |
| * First
Name of Contact Person: |
|
| * Last
Name of Contact Person: |
|
| * Company
Name : |
|
| * Contact Person's
Title : |
|
| * Full
Address: |
|
| * 2nd
Address, Apt.#, PO Box: |
|
| * Day Time
Telephone No.: |
Area Code:
City Code:
Tel. Number:
|
| * Night Time
Telephone No.: |
Area Code:
City Code:
Tel. Number:
|
| * Email
Address: |
|
| * City: |
|
| * State/Province: |
|
| * Postal Zip Code: |
|
| * Country: |
|
| * How many Web Pages
will you need? |
Total. Extra Pages Charged below if more than 4.
|
| * How many Total Images for
all Pages? |
Total. Extra images charged below if more than 40.
|
| * How many Total Links for
all Pages? |
Total. Extra links charged below if more than 50.
|
| * Do you need a Domain
Name Registered? |
Free 1 yr Domain w/Premium or $10 w/Free Hosting.
|
| * Do you need to accept Credit
Card Payments? |
1 PayPal Page allowed with Premium Hosting.
|
| * Select Web Site Package with :
|
Premium Hosting
or Free Hosting Must Choose One.
|
| * Cost of your basic Web Site Package :
|
|
* Setup and Help on Four Free Services:
Choose
First Free Service Selection: |
|
* Setup and Help on Four Free Services:
Choose
Second Free Service Selection: |
|
* Setup and Help on Four Free Services:
Choose
Third Free Service Selection: |
|
* Setup and Help on Four Free Services:
Choose
Fourth Free Service Selection: |
|
|
Mouse over &
correct each checked item that applies to your order to add to total. |
* Additional Web Pages you will need created,
if more than 4, at $25.00/page: |
this item 
Enter # of pages in box to add to total. |
* Additional Images you will be
using, at $1.00 per image: |
this item
Enter # of images in box to add to total. |
* Additional Links you will be
using, at $1.00 per link: |
this item
Enter # of links in box to add to total. |
* Additional Services you will be
needing help with, at $10.00/service: |
this item
Enter # services in box to add to total. |
* Graphics Designing at $ 35.00 per hour:
Banners, Images and Animated Gifs. |
this item
Enter # of hours in box to add to total. |
* Custom Programs Designed for $35.00/hour:
Any Application, Data Collection, PHP, SQL DB. |
this item
Enter # of hours in box to add to total. |
* If Free Hosting and or Extra Domain Names:
Registration Fee $10.00/year per Domain Name. |
this item
Enter # of domains in box to add to total. |
* Translate pages to Spanish for $25.00/page:
Other Languages Available. |
this item
Enter # of pages in box to add to total. |
* Describe the Site to be created.
(maximum 500 characters.) |
500 characters left. |
Total : Reload to update total.
Press Reset, to clear all fields and start over this form. * Required Fields.
|
