Information Form

g.gif (4316 bytes) Information Form
Please Fill-In

Let's talk about YOUR Web Site

Your Name (First & Last)
Street Address
City and State Zip:
Phone Number or E-mail Address

Name of Business
Business Address
City and State, Zip:

Billing/Contact Name:
Billing Address: City & State: Zip:

Type of Business: (e.g: Sales, Service, Information)
Below please give a Brief Description of your business.

Please list Three Choices of Domain Name: (.com = Commercial, .org = Organization, .net = Network)

1. (yourcompany.com, .net or .org)
2.
3.

I have selected a Background Yes   No     Graphic Yes    No      Back to Samples Page
                                                                                                                                 ( in case you forgot!)
If Yes, Please Enter Number or Name
Questions or Comments

I (the Client) fully understand that all Domain and Server Set-Up charges are fixed and will be paid up front by my company. Server Charges depend on type of Web Site Selected and are billed according to agreement with Gail Green Graphics.

I will return your call or E-mail Gail

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