Website Order Form Business Full NameEmail Zip/Postal CodePhonePlease provide your phone number so we may contact you for design details if needed.Set Up Fee* I want to be charged half of the set up fee now I want to be charged the whole set up fee now Monthly Service* Basic Monthly Service $69 Power Monthly Service $99 Power Monthly Service Includes: Marketing Landing Pages Proposal id #Monthly TotalIn placing your order for any Website, you will only be charged an initial hosting fee to get started. The set up fee will then be charged separately once the initial order has been received.Total Monthly $0.00 Credit CardCard Details Cardholder Name Signature*By submitting this Work Order with payment I agree to the terms and conditions of Internet Media Consultants.NameThis field is for validation purposes and should be left unchanged.