Website Design Application Form
Login Information
Username:
Password:
Hint Question
Hint Answer:
Personal Details:
Company Name:
Title:
Name:
Surname:
ID/CO Reg no.:
E-maii:
Postal Address:
Physical Address:
Address:
Address:
City:
City:
Province:
Province:
Code:
Code:
Contact Details:
Payment Details:
Tel (w):
Cash:
Tel (h):
Debit order
:
(optional)
Fax (w):
Account Holder:
Fax(h):
Bank Name:
Cell:
Branch Name:
Branch Code:
Account Type:
Account Nr:
Webdesign Packages + Added extras
Description:
Setup / Once Off
1.
5 Page Website
R2900
2.
10 Page Website
R4800
3.
Additional Pages
R350
4.
Information Forms
R550
5.
Static header/banner design
R300
6.
Online Booking Forms
R750
7.
Picture Gallery (Max 10 Pictures)
R500
8.
Opening to New Page or Popup
R50
9.
Maintenance per hour
R350
10.
Hit Counter
R300
Comments
Terms and Conditions :
Terms and Conditions
Accept all Terms and Conditions.
By submitting, I agree to all terms and conditions.