Site with Appointment System Order Form

[googlefont font=”Oregano” size=”26px” margin=”0px 0 5px 0″]Site with Appointment System Order Form[/googlefont]

Pls. fill up the order form below and we will get back to you to discuss your design plan. Once we have finalized your theme design and functionality, we will send you quotation. We require 50% downpayment for us to start your project. The balance of 50% is due upon completion of the project.

Customer Details

Your Name(required)
Company Name
Address(required)
Phone/Cel No.(required)
Email(valid email required)
Type of Industry

Order Details

Type of Service You want to Order
Preferred Domain to Register
Only domains with extension .com, .net, .org, and .info are free for this package. Domains with .ph extensions are not free. Click here to make an order for .ph domains.
Primary Domain Name(required)
Alternative Domain Names 1)(required)
Alternative Domain Names 2)(required)
Alternative Domain Names 3)(required)
Choose your preferred theme from our theme gallery. If no preferred theme, just type "no preference"
Theme Name
Preferred Theme Color
Special Instructions

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