DetroitPages.Com
Order Form
Please print this order
form out, fill in the information below and send it with your payment to the
address below.
Name: _____________________________________________________
Address: ___________________________________________________
City:__________________________ St._____________Zip: _________
Telephone: _________________________________________________
Email Address: _____________________________________________
| Website |
Price Each |
Quantity |
Total Price |
| Yearly |
$150.00 Each |
. |
. |
| Monthly |
$26.95 Each |
. |
. |
| Total Order |
|
|
. |
Terms: We accept Checks, Money Orders, and Credit
cards. If payment recieved is by check then we require 10 days for the check to
clear, Once we recieve your order, average time to complete your site will vary
depending on what is needed to build your site.
Make Check or Money Order payable to:
Richard Gory Jr.
2516
Emogene
Melvindale, Michigan, 48122
Enter your credit card information below, we accept Visa, Master Card,
Discover and American Express.
Name on Card:__________________________________________________________________
Card Type:_________ Credit Card Number:_________________________________
Exp. Date:___________CID#(if applicable-Required for
discover)__________
(Note:) Card type= V-Visa, MC-Mastercard, D-Discover,
AE-American Express
CID# is the 3 digit code on back of card (Last 3 digits
in white box).