1041 Oxford Drive

Lake Oswego, OR 97034


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: ____________________________

Web Site Hosting


1 ($29.95/month)
      2 ($54.95/month)
      3 ($79.95/month)
      4 ($199.95/month)



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


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)

($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?: ______________________________


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