Web-design Enquiry

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Please fill in the following form. The fields marked by red text are required for credit card customers. Otherwise they are optional.

From:

Buyer(s):

(on card)Firt Name: (on card)Las Name:

(Billing) Street Address: City:

Sate or Province: Postal Code:

Country: Credit card Number:

Expiration Date: Month Year

Amount to Bill: Invoice #:

Telephone:   Fax:
E-mail:        

The Buyer(s) would like to enquire about the service, terms and conditions mentioned below:

1.    Transaction Details

Service: Web design and development                            
Quantity                        , 
Unit pice US $ (optional)

if other, specify              
Amount  (optional)          
Mode and Terms of Payment             If other, specify
Delivery Time                           If other, specify


2.    Other Conditions: