Sign Up For A Small Business Website Sign Up for a Small Business Website Use this form to get start with a small business website Name* First Last CompanyEmail* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about us?-FlyerFriendMagazine/Newspaper AdOne of Our ClientsOther Website AdSearch EngineYellow PagesOtherWhich Friend Told You About Us?In Which Magazine/Newspaper did you see our ad?Which of our clients told you about us?Where did you see our flyer?On which website did you see our ad?Do you currently have a websiteYesNoCurrent website URL: What website URL would you like to have? Ex: http://mybusinessname.comHow quickly will the site need to be completed?Any Additional Information you would like us to know?Which design package would you like?*Plus - $799Pro - $999Platinum - $1,499Custom - $2,999You can view packages features HEREWhat hosting package would you like?*You Manage: All updates and changes are done by you using our simple content management system We Manage: We provide you with 1 hour of content updates per month. Just email us the changes and we will make them with 48 hours. We manage + Local SEO: We handle content changes up to 1 hour a month, plus we provide local search engine optimization service You Manage - $29.95We Manage - $59.95We Manage + Local SEO - $99.95How would you like to be billed?*MonthlyQuarterly - 5% discountSemi-Annually - 10% discountAnnually - 15% discountAdditional Services Needed? Logo Design Photography Services Mobile App Recurring Monthly App Hosting/Maintenance Price: $100.00 Recurring Monthly Charge Price: $0.00 Recurring Quarterly Charge Price: $0.00 Recurring Semi-Annual Charge Price: $0.00 Recurring Annual Charge Price: $0.00 Due Today: $0.00 Do you have a coupon code? Do you agree?*Do you agree to the terms and conditions found HERE ? I Agree Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name
