Secure Web Design Order Form

WEB DESIGN SECURE ORDER FORM
	Design Service

Business Gold Designer Site $990
6 custom designed pages with a contact form and 5 unique e-mail accounts, 10 aliases with an automatic e-mail responder, 6 custom designed images per page, keywords and meta tags optimized for better placement in the search engines and submission of your web site to 1500 search engines, link list , FFA�s and directories.
	please select	US $ 990
Business Professional Designer Site $1,690
11 custom designed web pages with 10 custom images per page, contact form, products/service order form with up to 30 products and 10 unique e-mail accounts, 10 aliases with an automatic e-mail responder, keywords and meta tags optimized for better placement in the search engines and submission of your web site to 1500 search engines, link list, FFA�s and directories.
	please select	US $ 1690
Business Platinum Commerce Designer Site $2,900
(must be a gold hosting customer to participate) 11 custom designed web pages with 10 custom images per page, contact form, complete custom MIVA shopping cart with up to 50 products designed to your specifications and 20 unique e-mail accounts, 10 aliases with an automatic e-mail responder, keywords and meta tags optimized for better placement in the search engines and submission of your web site to 1500 search engines, link list, FFA�s and directories
	please select	US $ 2900

INFORMATION about your Company


* required Fields	We need all information for your registration !
*Company:
* Your First and Last Name:
Title:
* Address:
* City:	*State:
* Country:	*Zip:
* E-mail address:
* Phone:
Fax:
Mobil Phone:
Toll Free:

INFORMATION about Billing


We accept:

* required Fields

* Credit Card:

* Credit Card Holder:

* Credit Card Number:

* Expiration MM/YY:

Illegible

	In an effort to reduce fraud we asking for the Security ID for the cards listed below. If your card does not have a Security ID on it you may leave the field blank. If the Security ID on your card is unreadable, you should check the "Illegible" box. See the links below for an image of the location of the Security ID on your card.

	American Express : Security ID is printed on front of card above the credit card number.
	Euro Card : Security ID if available is printed on back of card after the credit card number.
	Master Card : Security ID if available is printed on back of card after the credit card number.
	Optima : Security ID printed on front of card above the credit card number.
	Visa : Security ID is printed on back of card after the credit card number.

Credit Card Billing Address

* Postal /Street Address:

* City:

*State:

* Country:

*Zip:

Additional Info's:

INFORMATION about our Web Hosting and Design Service


		I agree to your Web Design Terms please read

		Setup fees are non-refundable. Thanks for your order ,your Web Designers will contact you ASAP. Your Web Design and Hosting Team


	Any Question please call 1- 888-398-4703 or international +1-760-736-3700

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