Please note: The information collected from this form will be used within your site therefor
     ALL questions must be answered except where noted as optional.
Do you have a Registered Domain Name?:

YES       NO

If Yes, please enter your Domain Name/URL here:
http://www.  . 
If No Click Here to register your Domain Name
OR
Click Here to transfer an existing Domain Name to our services.
Will you be bringing your own Graphics?:

YES       NO

Are you purchasing or have you purchased one of our Graphics Packages?:

YES    NO    Still Looking

What type of Website are you creating?:
Arts and Crafts ($20.00/month)
Small Business: not art/craft related ($20.00/month)
Store Front: non-selling ($10.00/month)
Personal Homepage: non-selling ($10.00/month)
What Layout do you plan on using for your Website Template?:
Arts and Crafts
        or
Small Business: 		A B C
View Samples
Store Front: A    
View Sample
Personal Homepage: A    
View Sample
First Name:
Last Name:
Business Name:
Email Address:

             (*must be current/valid)
Alternate Email (optional):
(for submissions and junk mail)
Street:
City:
State/Province:
Country:
Zip/Postal:
Phone:
(include area code ie: 613-744-1234)
Private?:  Public?: 
Fax:
Tax Rate:
(for your State/Prov)
%
Do you accept MasterCard?:

YES       NO

Do you accept VISA?:

YES       NO

Do you accept AmericanExpress?:

YES       NO

Do you accept Discover?:

YES       NO

Do you accept PayPal?:

YES       NO

Do you accept Money Orders?:

YES       NO

Do you accept Checks?:

YES       NO

Make Checks Payable to?:

Your Name
Business Name

Referred By:
     


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