Order Form

- Date

- Sales Rep

- Email *

- Business Name

--- Telephone

--- Fax

--- StreetAddress

--- City

--- State/Province

--- Zip/Postal Code

--- Country

- Representative #1

--- Email

--- Telephone

- Representative #2

--- Email

--- Telephone

- Website Address

Already Owned? -------------------- Yes Yes & Transfer No --- Already Owned?

- Second URL Choice

- Third URL Choice

- Project Start Date

Select ------ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select --------- January February March April May June July August September October November December Select ------ 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 - Completion Date

- Client's Favourite Website

- Least Favourite Website

Sections of the Website:

Select -------------------- Yes No Some - Client Supplied Text

Select -------------------- Yes No Some - Client Supplied Photos

Select -------------------- Yes No Some - Client Supplied Graphics

Select -------------------- Yes No - Client Supplied Logo

Possible Keywords for SEO:

Select -------------------- Yes No - Standard Hosting Package

Comments About Enhanced Hosting:

Select -------------------- Yes No - Standard Website Package

Comments About Enhanced Website:

Select -------------------- Yes No - Standard SEO Package

Comments About Enhanced SEO:

- Amount of Retainer

Select -------------------- Credit Card PayPal Cheque - Preferred Payment Method

--- Type of Credit Card

--- Name on Credit Card

--- Credit Card Number

--- Security Number

Select ------------ Jan. (01) Feb. (02) Mar. (03) Apr. (04) May (05) June (06) July (07) Aug. (08) Sept. (09) Oct. (10) Nov. (11) Dec. (12) Select ----------- 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 --- Expiry Date

Additional Questions & Comments: