*
First Name:
*
Last Name:
*
Mailing Address:
*
City:
*
State:
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*
Zip Code:
*
Company Name:
*
Email Address:
*
Telephone:
(
)
*
Home & Family Design Scheme: *
Click
to see Home & Family designs.
Select
Design
#HF004
Design
#HF023
Design
#HF038
Design
#HF044
Design
#HF052
Design
#HF054
Design
#HF055
Design
#HF070
Design
#HF175
Design
#HF182
I
will discuss options with desginer
*
Logo Title: *
Usually Company Name
*
Your Company's Industry: *
This helps us select the proper
photos
*
to establish your site's theme.
*
Slogan:
*
Additional Design Comments:
*
Home Page Content: *
Cut & Paste any text you may
have for the home page.
If not sure
*
about the text for
the web site, skip this
section and send it to us later.
*
Page Title #2: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #3: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #4: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #5: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #6: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #7: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #8: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #9: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Page Title #10: *
Ex: Products, Services, Contact
Us
*
Cut & Paste text below:
*
Do you currently have a web site *
or a registered domain name:
Yes
No
*
If yes, enter web site address: *
Ex: www.mysite.com
*
If no and would like us to register
*
your domain name for an annual
*
feeof $14.95 enter
it here: *
Ex:
www.mysite.com
*
Would you like us to host your site:
*
Hosting
Fee: $5.95 TO 12.94 per month
*
Junior
$5.95 - Delux $9.95 - Delux Plus with CGI
*
$10.95 - Delux
Plus with ASP $12.95
*
Click
Here to See the Differences
*
Between the Different Hosting Costs.
Yes
No
Not Sure
Junior
Delux
Delux Plus CGI
Delux Plus ASP
*
If referred to our program, please *
enter referral code here: