Quick Web Design Order Form - Please print clearly and fill out all fields. Thank you.
Business Name
____________________________________________________
Mailing Address____________________________________________________
Street Address____________________________________________________
Telephone____________________________________________________
Fax Number____________________________________________________
Products____________________________________________________
Services____________________________________________________
Years in Business and Other Facts____________________________________________________
Persons to contact in Company and Titles ____________________________________________________
Company Slogan, Motto____________________________________________________
E-mail if already have or desired for Web Site name____________________________________________________
E-mail password desired____________________________________________________
Sub Total$95.00 per Quick Design Web Site Setup........Quantity______ ..................... $____________
Mail with payment to:
Mary Sivright, 7852 Hart Dr NE, Fort Myers, FL 33917-2444
SHIP CONFIRMATION DOCUMENTS TO:
Area Code & Phone:_______________________________
NAME:_________________________________________
STREET:_______________________________________
CITY:_______________________________
STATE:_______ COUNTRY:_______________ ZIP:___________
E-MAIL ______________________Special Instructions_______________________
Check ____Money Order(same day design)_______
Type of Credit Card:Visa____MasterCard____Discover____AmericanExpress___
Name as Shown on Card:_______________________________
Expiration Date:_______ Signature___________________________
All credit card orders will require signature acceptance
For Fastest Shipping Send Money Order
Make payable to Mary Sivright.
Thank you for your Order!!
For International Orders add extra $5.00 shipping and handling for customs and duty fees.
Please allow 10 days for International Delivery.
E-mail:Mary Sivright at Angelfire.com
