logo.gif (8315 bytes)

Site Submission Order Form
this is a Secure Form

Please fill out the form completely so your order can be processed. After payment is processed and your site submission completed, you will receive a complete site submission report via email.

Name
Email
Company Name
Street Address
City/Town
State/Province
Zip/Postal Code
Country
Phone
Fax
Page Title (this is like a headline that would get people to your page):
Your URL:
Keywords (3 words or phrases, separated with commas):
Describe what you're offering on your web site in 15 - 20 words:
How did you find this site?:
Method of
Payment
Visa or Mastercard


Name on Credit Card
Credit card number
Expiration Date /

Your credit card will be charged $25.00
and the vendor shown on your statement will be Internet Magic.


Check or Money Order

Please make check or
money order payable to:

Internet Magic
5111 York Court
Cape Coral, FL 33904


   

 


Hosting Plans button.gif (2439 bytes) - low cost web hosting   Order_Form_button.gif (2285 bytes)   Free Domain Registration button.gif (2764 bytes)
Site Submission button.gif (2558 bytes)   Classified Ad_Submitter button.gif (2693 bytes)    Home.gif (1435 bytes)

FreeWebHost.com
5111 York Court
Cape Coral, FL 33904
1-877-201-8859 toll-free 707-869-3389 phone
404-806-6979 fax
support@freewebhost.com