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Order Form - 
101 Quick Web Page -
At last, a faster, easier, economical way to advertise on the internet. 

Fill in the following fields with the information you want to appear on your 101 Quick Web Page.  It is OK to leave any optional fields blank or just enter NONE. (Required fields are marked *)

Your full name and title:* (This is a required field but if you don't want it published indicate so in the comments field below.)
(e.g.: Jimmy J. Jones, owner)

Your email address: * (This is a required field but if you don't want it published indicate so in the comments field below. If you don't have one enter NONE.)
(e.g.: you@mindspring.com)

Your company/school/organization/event name: *Required.
(e.g. "Great Shoe Repair Shop")

Your voice phone number *(This is a required field but if you don't want it published indicate so in the comments field below.)
(with country, city, area codes): 

Your fax phone number.
(with country, city, area codes): 

Your pager phone number.
(with country, city, area codes): 

Your toll-free phone number. 
(with country, city, area codes): 

 *(These are required fields but if you don't want it published indicate so in the comments field below.)
Address:
City/Town: State/Prov.: Post./Zip Code:
Country:

The applicable service area:
(e.g. city, county, state, country, etc.)

Year company was established:
(e.g. 1995)

What services or products do you provide?:

What colors do you prefer?

(for text, border, and background.) (cool (blues), warm (reds), cold (gray), etc.)

Use the text box below to add any comments or additional information you might like on your web page.  This could be a company slogan, current clients, past successful projects, names of the company principles, special capabilities of your company, etc.  Please be concise.

I want to pay by: *Required (Pull list down and select one)

 

Payment page will follow.

 

At last, a faster, easier, economical way to advertise on the internet.

If you have questions or a digital logo or image you want to include on your web page attach it to an email and send it to Webdesigner@101science.com.  Be sure to include your full name and your company name so we can match it up with your order.

NOTICE:  This service is NOT available for adult, gambling, or any illegal or immoral activity as determined by 101science.com. We reserve the right to refuse any request for a 101 Quick Web Page not meeting these basic requirements.


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