Order Form

Please leave the fields that are not applicable to your order blank.

As many of the products are subject to individual requirements and pricing, an invoice for payment will be emailed to you as soon as the order is received.

Most payments must be made in full before the commencement of work. PayPal or Clickbank offer easy and secure transactions, as well as flexible payment schemes.

Name:.

Email:..

Phone:.

Product 1: - Browser Based Editor Custom Built Website Customized Web site Ezine / Newsletter Pre-Loaded Web site Rent-a-WebsitE Add On Services ..........Product 2: - Browser Based Editor Custom Built Website Customized Web site Ezine / Newsletter Pre-Loaded Web site Rent-a-WebsitE Add On Services

Product 3: - Browser Based Editor Custom Built Website Customized Web site Ezine / Newsletter Pre-Loaded Web site Rent-a-WebsitE Add On Services .........Product 4: - Browser Based Editor Custom Built Website Customized Web site Ezine / Newsletter Pre-Loaded Web site Rent-a-WebsitE Add On Services

If you are using a professional template as part of your package, please quote the # here. Alternatively, you can purchase templates separately via the template shop (in which case please forward downloading links to : info@DesigN-a-WebsitE.com.au

Template # :.

Purchase Outright ..................Installments .................. Monthly Billing ..

Additional Information:

Do you require the following services?

Hosting ................ Domain Registration ................. Add On Services

If domain registration is required and you want DesigN-a-WebsitE to purchase on your behalf, please note your preferences here.

Domain name preference 1 :

Domain name preference 2 :

Domain name preference 3 :

Please note: .com.au domains require an ABN at time of registration.

Australian Business Number (ABN)

If you require a flash display, please select from the following:

Flash Banner ....... Advertising .......... Product Display ......... Photo Slides

Page Requirements:

Number of Pages 1 2 3 4 5 6 7 8 9 10+

Text Font : .....Heading Font :

Menu Font : .....Other :

Please list preferred keywords here:

Colour Scheme :
Please refer to the colour chooser on this website for colour codes:

Bg # . Text # ..Menu #

Banner # ....Heading # .....

Other colour notations :

Web site examples that emulate the look and feel you want to accomplish for your business:

Web Site Address 1 :

Web Site Address 2 :

Optional : the following FTP details may be emailed after ordering if you need to contact your server for the details.

What is the host name or FTP address of your Web server?

what is your FTP login?

what is your FTP password?

Additional design notes: