Order Form

When directed, click HERE to return to main site.

All the information gathered on this page will be considered confidential, and will not be used in any matter not directly related to setting up the accounts of WebMasters of Dayton and/or the web host.

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please enter your choices for a domain name (ex: www.yourdomain.com), beginning with your top choice listed first. List as many as you can because your top few choices may not be available.
Please describe in as much detail as possible what you want your new web site to look like, and what features you would like installed. Example: What colors, if you want a message board, chat room, etc.

Please provide the following credit card information for the web host.* You will be billed by StartLogic once each year at the rate of $7.50 per month. This first payment will be at the reduced rate of only $70.50 for your first year. After that, the yearly fee charged to your credit card will be $90.00 plus any due state tax.

	BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date (ex: 01/08)

* WebMasters of Dayton will not be billing your credit card for setting up your account. The credit card information is being requested to correctly set up your account with the web host, StartLogic. You only pay WebMasters of Dayton after you approve your web site, and that will be by check or money order only.

Order Form

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All rights reserved.