U-Web Internet Services Online Order Form

SEVICE REQUESTING : Web Page Compiling or Consulting
Print and send form plus Check/Money Order/Cashier Check payable to:
UWIS
1200 McKinney, Suite 411-242
Houston, TX 77010


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 : ___________________________________