WEB SITE ORDER FORM
Name: ______________________________________
MI: _____ Last: ___________________________
Full Mailing Add: _______________________________________________
City: __________________
State: ___________________________ Zip Code: ________________________
H-Phone: ______________________________
Cell Phone: ___________________________________
Email Add: ____________________________________________________________________________
Desired Domain Name: ( We suggest that you try and keep it short as possible because it is much easier to advertise
- but it's up to you - Please give me at least three choices! In each case I will first go for a .com, then a .net,
then a .buz, then a .org. for each of your choices before I go for your next choice. Be advised that almost all
three letter domain names have been gone for several years. I also suggest you go for something like www.godowdy.com,
(my site) or something like www.joeblow.com or just www.johnblowi.com or www.goblow.com or www.gobettygo.com or whatever!
If you send me something that is way off I will call you and talk about it before I try and secure is as once that is done
... I cannot change it!
Choice #1.
_________________________________________________________
Choice #2: _________________________________________________________
Choice #3. _________________________________________________________
Choice #4: _________________________________________________________
Please tell me something about what you want to say at your site. If you like I will build it and than you can
review it and then tell me what changes you want! That's what most people do!
Please select one
of the following:
____ a. Place a one year order and you pay only $129.00 per year, (this is a $20.00 saving)!
____ b. Place a two year order and you pay only $119.00 per year, (this is a $40.00 saving)!
____ c.
Place a three year order and you pay only $109.00 per year, (This is a $60.00 saving)!
____ d. If ordered
for FIVE years in advance I can sell them for $99.00 per year, (This is a $50.00 savings)!
Method
of payment:
__ Check, ___ Money Order, ___ VISA, ___ Master Card, ___ Discover, ___ A/Express!
Card
#: _________ __________ __________ ___________ Exp. Date: _________ SEC # __ __ __ (On back)
Name On Card:
______________________________________________________________________
Billing Address: _____________________________________________________________________
Signature: ____________________________________________________
date: _______________
Please note: Credit card payments will be made payable to:
DOWDYNSON.COM aka
HEALTHY LIFE PRODUCTS
