1041 Oxford Drive Lake Oswego, OR 97034 USA

Web: www.blizzarddesign.com Ordering Information

Please print then fill out the following form and send it to the address above. (Bold Fields Are Required)

First Name: ______________________ Last Name: _______________________

Company Name: ______________________________________ Position: __________________

Street Address(1): _______________________________ Street Address(2): _____________________________________

City: _______________________ State: __ Zip Code: __________________

Daytime Phone: (____)-____-______ Evening Phone: (____)-____-______

e-Mail Address: ____________________________

Services-

Web Site Hosting Plan: 1 ($29.95/month)       2 ($54.95/month)       3 ($79.95/month)       4 ($199.95/month)     Domain: ___________________________________     Choose One: This is a new domain name.       This is an existing domain name.       I don't want a domain name now.     Site Title: ___________________________________           Web Site Design Plan: 1 ($79.95)       2 ($95.95)       3 ($149.95)     Choose One: This is a new web site.       This is an existing web site.       I don't want a web site now.     Monthly Maintenance: Yes ($21.95/month)       No           Marketing/Promotion ($16.95 per site)       (Included in Design plans)

Yes I have read and agreed to the terms of service for an account with Blizzard Web Design     (box must be checked for acceptance of application.)

Where did you hear about Blizzard Web Design?: ______________________________

Blizzard Web Design - Copyright 1997-2000