Order Form
New Web Site

Use the form below to place your order.  Just enter your information and click on the "Send" button.  As always, we respect your privacy. Your answers are for Asset Web Design internal use only and will not be sold or given to anyone else for any reason.

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Company Information:
Company Name:
Street:
Suite / Apartment:
City:
State:		Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip Code:
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Contact Information:
Contact Name:
Title:
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Phone:		- -   ext.
Cell Phone:		- -   ext.
E-mail:
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Web Development (one-time):
Domain to Register:		(included with package)
Package:		Fast-Track Site - $295 Custom Site - $2,850 Deluxe Site - $5,850
Sales Tax:		8.25%
Total:
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Web Hosting (monthly):
Package :		Basic Hosting       1/2 hour content updates per month       $24.95 / month Advanced Hosting       1 hour content updates per month       search engine submissions       $55 / month  None
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Special Notes:
Notes:
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Misc.:
I agree to provide all text / image content in electronic format (JPG, Word, etc.).
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Credit Card:
Type:		VISA MasterCard American Express Discover
Name On Card:
Card Number:
Expiration Date:		January February March April May June July August September October November December     2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Security Code:
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Billing Address:
Copy Company Address:
Street:
Suite / Apartment:
City:
State:		Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip Code:
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Last modified on 2/18/2010 2:51:57 AM