Please complete the following information:

Name: ______________________________________________________________________

Address Line 1: ______________________________________________________________

Address Line 2: ______________________________________________________________

City: _________________________________ State: _____________ Zip: _______________

E-mail address: ______________________________________________________________

Phone Number: _________________________ Fax Number: _________________________

Reference URL: ______________________________________________________________

Description (up to 5 paragraphs - see samples for a better idea):

You may attach a separate sheet, or write on the back of this sheet when you print it.

Please attach a photograph (up to 5" x 7"), or a clear copy of your logo, or some other printed image such as a brochure or advertisement. We will scan this image into the computer and include it on your Instant Web Page!. The finished size of the image on your page will depend upon the format you have selected.

Please select format: _____ Large Format _____ Medium Format _____Small Format

Please select method of payment:

____ Check # _______ drawn on (bank) ________________________ Amount: $_________

____ Credit card: _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Expires: _ _ / _ _ Amount: $__________

____ MasterCard ____ Visa _____ Discover (These are the only credit cards we can accept.)

I wish to contract with Instant Web Pages! to create a web page for me or my business with the information shown above. I have checked all the boxes and have included a check drawn on a US Bank or provided my credit card information. I understand that you will have my Instant Web Page up and running at alamaison.com within 48 hours of your receipt of this completed application.

Signature: ______________________________________________

Date: __________________________________________________

Send this application with your image to be scanned and payment to:

Instant Web Pages!
c/o Ohain International Corp.
Post Office Box 389
Osterville MA 02655 - USA

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 Instant Web Pages! and alamaison.com are trademarks of Ohain International Corp.
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Copyright © 1997 Ohain International Corp. All rights reserved.
send email to: instantweb@ohain.com

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