U-Web Internet Services Online Order Form
SEVICE REQUESTING : Web Page Compiling or Consulting
Name:________________________________________
E-Mail: _______________________________________
Company: ____________________________________
Street Address: _______________________________
City, State, Zip: ________________________________
Phone: _______________________________________
Special Instructions: _______________________________________________________________
____________________________________________________________________________________
Payment Type
_____Credit Card_____Check, _____ Monery Order , _____ Chasier check
Credit Card/Check/Money Order/Cashier Check# ________________
Credit Card EXP. DATE ________________________
Name on Credit Card _____________________________________
Service Requesting:____Web Page Compiling  ____Web Page Consulting
Payment Terms : $10.50 per hour
AMOUNT:Amount $__________
Accounts Include:
Prices include page design & maintenance,
Signature : ___________________________________