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The following form will cover most situations.  However, feel free to call us if it doesn't fit your needs or you have questions -- or would prefer to give us your information over the phone.  We're happy to meet in person regarding web design work if you're in the Houston area.   We charge a consulting fee of $75 which will be applied to your web design costs if you decide to proceed.

PERSONAL INFORMATION

Your Name:

Address:

City:  

State:     Zip Code:

Phone:

Fax:

Primary E-mail:

Alternate E-mail (if any):

COMPANY INFORMATION (if different)

Company Name:

Address:

City:

State:    Zip Code:  

Phone:  

Fax:

CREDIT REFERENCE (REQUIRED FOR WEB DESIGN ONLY)

Company 1:

Phone Number:

Company 2:

Phone Number:

Web Hosting Requests

My domain name (if any):

I have a website I will be transferring: Yes

Please retrieve my existing site and upload it to SiteSamples server ($45 minimum): Yes
(Note: we will send you a client "to do" list so you will know what information we need to do the above.

Type of Hosting:
Basic  ($24.95)     Store ($44.95)    Commercial($59.95)       SQL ($79.95)
I will pay (choose one)
     Monthly
     Semi-annually
     Annually  
(The amount due will be adjusted accordingly if paying monthly or semi-annually)

Check if you wish to discuss shopping cart options

I understand there is a one-time setup fee ($40) for hosting.  
I need a SQL server site & understand there is a one-time setup fee of $79.00. 
I understand shopping carts must have their own SSL certificate @ $49/year

Web Design Requests  (Optional)

If you're interested in web design, please complete the following section to let us know what you're looking for.  We will then call you to discuss details. 

Please briefly describe your company.

What would you like your website to accomplish?

Please provide the URL of a website(s) of the size and type of site you'd like?


I understand that web design is $80/hour   

 

Website Management Plans   (Optional)

Mini Plan (only for sites we host):     $35/mo    Includes 30 min/mo.  Add'l time, if needed: $70/hr
Basic Plan:                              $75/mo    Includes first 1.25 hrs/mo.  Add'l time, if needed: $60/hr
Basic Plus SEO Plan:               $220/mo  Includes first 4 hrs/mo.   Add'l time, if needed: $55/hr
Commercial Plan:                   $450/mo  Includes first 10 hrs/mo.  Add'l time, if needed: $45/hr.

INITIAL TERM & CANCELLATION POLICY:
I understand that there is a initial 5 month commitment (payable monthly), and if I wish to cancel after the 4th month or thereafter, I will provide 30 days notice.  Please initial to confirm you agree to provide notice:______ 
 

Internet Advertising Program Management (optional):
(Note: not available with Basic Plan unless that's all you intend us to do with your time.)
If you want us to setup and/or monitor your Google or Yahoo! Search advertising program, please specify your monthly advertising budget. This is charged directly to your card by Google Ad words and/or Yahoo! Search.
$ Monthly ad budget payable to Google and/or Yahoo!
We will discuss search words and so forth before proceeding.
To truly manage/maximize an online advertising program requires a minimum of 3 hours/month so please choose the appropriate maintenance plan.  

Other comments/questions:

Payment info:

Cardholder Name:

Card Type:

Address

Card Number

City: State Zip:

Expiration (mm/yy)

 

CVV (security code on your card)

 

 

Payment & Legal Information:  The charge will appear on your statement as SiteSamples.  All billing is done in advance for hosting.  Web Design requires a $300 downpayment and is billed on a progress basis thereafter.  Web Design may be paid with a business check, but all hosting is billed on Visa, MC, or American Express.  We will accept checks for web hosting only if paid quarterly, semi-annually or annually.

All routine billing for hosting, etc. is from the 24th to the 23rd. Invoices are emailed on the 23rd and your card is charged 2 to 3 days later.  Payment is considered late 4 business days after invoicing.

Payment received after the due date incurs a $20 late fee.  If payment is more than 20 days late, we will take the site down and reinstatement is $100 plus past due and late fee.  $25 charge for returned checks.  Aren't deadbeats a drag?    

Cancellation Policy: We require 30 days notice for cancellation of any services.   If you did not buy your own shopping cart license initially, you may need to do so before your site will work with another web host.

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email
sales@sitesamples.net

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