To place an on-line order for a QUICKWEB website, click here.
FAX ORDER FORM
 Complete and print this form, then fax it to (954) 538-9588 or (954) 602-1091
Site Plan: Info Site Order Site E-Commerce Site  ( Click here for details of site plans )

Site Title:

  ( 5 to 15 words )

Description:

Business Name:

Slogan:

First Name:

Last Name:

 Street Address:

Phone:
Fax:


 Mailing Address:

Cellular Phone:
Toll Free Number:


 E-mail:

Business Card Email Address:

Text to be displayed on Info Site:

Website address (URL):
Type of Website Package:

Keywords
for Search Engines:

Payment Options
I will pay for the website creation ordered by check, and will mail the check and all materials for my site to the address below.
I will phone (954) 602-1091 or (954) 538-9151 to make all arrangements for creating and paying for my website.

Mailing Address :
  Owen Cooke
  12330 NW 18th St.
  Pembroke Pines, FL 33026
  U.S.A.
Phone Numbers:
  (954) 602-1091
  (954) 538-9151
Fax Numbers:
  (954) 538-9588
  (954) 602-1091
  (509) 272-9605
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