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For Flash Sample Messages

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SITE BUILDER ORDER FORM
Please complete the entire form and click Submit

COMPANY INFORMATION:
Transaction Number If Applicable
Name :
Business Name :
Address :
Address Line 2 :
City:
State :
Zip Code 
Phone 
Fax 
E-mail 
Email address you would like the "Contact Us" Form Forwarded To
SITE INFORMATION 
Master Design Number
Color Number
(See Table)		 Primary     
Secondary
Buttons    
Site Header
Tag Line
Menu Buttons Names





Please Type or Paste in text for Home Page. No more than 300 WORDS.
Please Type or Paste in text for page 1. No more than 300 WORDS.
Please Type or Paste in text for page 2. No more than 300 WORDS.
Please Type or Paste in text for page 3. No more than 300 WORDS.
Please Type or Paste in text for page 4. No more than 300 WORDS.
Please Type or Paste in text for page 5. No more than 300 WORDS.
META TAGS (Hidden words for search engine positioning)
Title Of Your Site
(15 words Max)
Description Of Your Site
(25 words Max)
Keywords - Key Phrases- 30 words people might query to find you
(with comma between the words and key phrases)
FLASH ANIMATION
Flash 1 | Flash 2 | Flash 3 | Flash 4 | Custom | None
Type Your Own Message Line 1 Samples
Type Your Own Message Line 2 Samples
Custom Flash animation with sound available starting at $199.00
STREAMING VIDEO (Up to 1 Minutes Included)
· Rewind your video to 5 seconds before you would like it to start
· Send it to us along with a pre-paid mailer if you would like to have it   returned
· We accept 8mm, VHSC and VHS video tape
Edited commercials with professional voice-over and music available starting at $299.00
Will you Send Video? YES        NO
DOMAIN / ISP INFORMATION
Do you own a domain?
{www.yourname.com}
If you have no domain name registered, please list 3 choices:(with the www).
Your first year's registration is paid for. Your next year will be charged at $35.00


To search for an available name, go to www.directnic.com to see if your domain name is available.
Additional Comments
CREDIT CARD INFO 
Your credit card will be charged for a one-time setup fee of $99.00
plus your first months hosting fees. You agree to not cancel this one-year contract. This card will be charged at the 1st of each month for your hosting fees. This contract will renew at the end of the term of the contract, unless a 30-day written notice is received.
Full Name (as appears on your card): 
Credit Card : 
Card Number : 
Expiration Date : 
This is a completely Secure Form

 

Contact: sales@cybercastmedia.net

 

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CDC is a division of Cybercast, Inc.

For additional products and custom web design go to our corporate site at:www.cybercastmedia.com