information form

      

   

   


This Information will assist us in Designing & Creating your web pages.

Please provide the following contact information:

Name
Title
Organization
Work Phone
FAX
E-mail
Requested URL Name

Please provide the following descriptor:

Simple, Detailed or Intensive Site:

Please provide the type of payment you'll be using:

BILLING
Credit Card

Check (Name of Bank)

Location of Bank

Cashier's Check or Money Order

 

Billing Address
Street Address
Address (cont.)
City
State
Zip/Postal Code
Country

Please identify and describe yourself:

Date of Birth mm/dd/yy
Sex Male Female

Choose one of the following options to describe the type of site you'd like:

Entertainment
Information
Product For Sale
Service For Sale

Please tell us if you have JPEGS, Sound Files, a Physical Store Location, a registered

Merchant Account, or do these things to be created for you:


Please state what you'd like to achieve with a website:


 

You will automatically be returned to the Home Page upon clicking Submit.


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