Contact Information
(Please fill out completely):
Company Name:
*
Your Name:
*
Address Line 1:
Address Line 2:
City:
State:
Zip:
Phone#:
*
Type:
Home
Cell
Work
Day
Evening
Alt Phone#:
Type:
Home
Cell
Work
Day
Evening
Fax:
E-Mail:
*
Please type none if no e-mail.
*
required so that we can confirm your request.
Order Information
(Select all products being ordered):
Web Hosting:
None
BDWH---Basic Hosting Package---$5.00/mth
BDWH---Standard Hosting Package---$10.00/mth
BDWH---Advanced Hosting Package---$15.00/mth
BDWH---Professional Hosting Package---$20.00/mth
Web Design:
None
BDWD---Starter Web Design Package---$600
BDWD---Basic Web Design Package---$1,000
BDWD---Enhanced Web Design Package---$1,500
Project Details
(Explain in detail the extent of your project):
Details:
How did you hear about Balistyk Designs?
How did you hear
about us?
Business Card
Search Engine
Client Website
Newspaper
Friend/Neighbor
Other
