Business Basic Website Membership Profile
Business Name _______________________________
Address _____________________________________
City _______________ St__________ Zip _________
Domain Name Request
1st Choice_________________________________
2ond Choice_______________________________
3rd Choice________________________________
Company Logo? _______________________
Branding Slogan?_______________________
______________________________________
Photos ________________________________
Contact Us Info
Street address___________________________________
City ______________________ St______ Zip _________
Phone? _______________ Phone 2? _________________
Fax ___________________
Email address? __________________________________
Web Pages
Home Page __________________________________
_______________________________________________
Child Page 1 ____________________________________
_______________________________________________
Child Page 2 ____________________________________
_______________________________________________
Child Page 3 ____________________________________
_______________________________________________
Child Page 4 _____________________________________
________________________________________________
NOTE: Please Attach Bio For About Us Page
Email Logo / Photos / Bio to webmaster@waccamawweb.com
Yes design my new 5 page business website for only $ Name ________________________
And $ Per Month for hosting.
Signature _____________________
Date _____/_____/_____
