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Web Pros Sales Order Entry Form

General Site Information:
Domain Name: www. (Required)
Registrar Status: New Domain (Network Solutions issues registration invoice)
Domain Relocation
Not Applicable
Registrar:
 
Business Web Site Hosting Options:
Hosting Fee (annual):
Setup Fee (one-time):
Service Option #1:
Service Option #2:
 
Domain Name Pointers:
Domain Pointer Names:
Service Fee (annual): Qty:
Setup Fee (one-time): Qty:
 
E-Commerce Options:
Software: Qty:   
Training: Hours:
 
Site Development / Support Fees:
Fee 1: Hours:  
Fee 2: Hours:  
Fee 3: Hours:  
 
Credit Card Billing Information (Required):
Card Type:
Card Number:
Expiration Date: (MM/YY)
 
Name on Card:
Card Bill Address 1:
Card Bill Address 2:
Card Bill City:
Card Bill State:
Card Bill Zip Code:
BILLING COMMENTS:
 
Client Contact Information:
Same as Credit Card Information
Organization:
Contact Name:
Address 1:
Address 2:
City:
State:
Zip Code:
 
Phone Number:
Fax Number:
Email Address:
 
MAIL INVOICE TO:
    (Required)		 Credit Card Billing Address (above)
Client Contact Address (above)
Domain Registrant Address (Network Solutions)
Other (specify below):
 

 

 

 

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