WEBSITE FAX ORDER FORM

 To order by fax, complete this form now, then print it and fax to (876) 969-3288.

Site Plan: Info Site   ( Click here for details )

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 (URL):
 

Keywords
for Search Engines:

Payment Options
I will pay for the website ordered by cheque, and will mail the cheque and all materials for my site to the address below.
I will phone (954) 602-1091 or (954) 538-9186 or fax (954) 538-9588 to make all arrangements for creating and paying for my Quickweb website.

Mailing Address :
  Ozanam Home for the Aged
  38 Mannings Hill Rd.
  Kingston 8
  Jamaica
Phone Number:
  (876) 924-3982
Fax Number:
  (876) 969-3288

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