Print & Mail this Form!

Order Form
Personal Information:

Name:
___________________________

___________________________

Company Name: (optional)

__________________________________
Phone:
(        )_____________________
Fax:
(        )_____________________

Address:
__________________________

__________________________

__________________________

__________________________

__________________________
E-mail Address:

__________________________

q       I’m enclosing $45.00 as a down payment towards the design of my web site.  Once my site is complete and viewable on the Internet, I agree to pay the additional amount. 
 

Payment Method:
 O Cash / O Cheque / O Money Order

Make payable to: Ashley Brazeau

Signature:___________________________

Date: ______________________________

Remember to secure proper Canadian postage. 

*This offer is valid worldwide…

The content of your sight will be kept confidential, no matter what subject matter you may be producing.

 Ashley Brazeau
Web Design
454 Dominion St.
Pembroke, ON  K8A 4W8
Canada