Network of Condos: Mobile Website Order Form

Website Information:
Number of Websites*
- One
- Two (second site half price)
- Three (second and third sites half price)
One Mobile Site
Price:
Two Mobile Sites
Price:
Three Mobile Sites
Price:
URL of Website #1*

eg. http://www.mysite.com
URL of Website #2*
URL of Website #3*
Contact Information:
Name*
First Last
Address*
- Use Address on File
- Enter New Address
Address Details*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Payment Information:
Payment Method*
- Credit Card on File
- Enter New Credit Card Information
Credit Card Information:
Credit Card Type*
Credit Card Number*
CSV/CVV Code*
Expiry Month*
Expiry Year*
Terms of Service*
- I have read and agree to the Terms of Service

dazil Internet Services