| FREE Web Design Package Agreement | Click here to print this page. |
Please PRINT this form and
clearly write in the information for each blank and fax to us at (775)535-8301.
Note: Forms with typed responses will NOT be accepted.
Personal Info
| First Name: | ___________________________________ |
| Last Name: | ___________________________________ |
| email: | ___________________________________ |
| Telephone: | ___________________________________ |
| Company Name: | ___________________________________ |
| Address: | ___________________________________ |
| City: | ___________________________________ |
| State: | ___________________________________ |
| Zip: | ___________________________________ |
| Country | ___________________________________ |
Package Info
| Domain Name: | ___________________________________ |
| Design: | 
Template 1, Template
2, Template 3,
Template 4, Template 5,
Template 6, New Concept |
| Package: |
Dream WEB, Ultra
Dream WEB, Style
WEB, Ultra Style
WEB, Concept WEB,
Ultra Concept WEB,
Lite WEB |
| Payment Term: |
Monthly, Yearly,
Biyearly |
Payment Info
| Card Type:: |
Visa, Master,
American Express |
| Name on Card: | ___________________________________ |
| Number: | ___________________________________ |
| Expiration Date : | Month___________Year_______________ |
| Billing Address : | ___________________________________ |
| City: | ___________________________________ |
| State: | ___________________________________ |
| Zip: | ___________________________________ |
| Country | ___________________________________ |
Terms and conditions:
I understand all terms
and conditions on this
page.
* please check the box if you agree with term and conditions.
If you have any questions
or wish to check more, please use this
page.
| Name: | ___________________________________ |
| Title: | ___________________________________ |
| Signature: | ___________________________________ |