Site-City General Order Form

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General Services
ORDER
& Info Request FORM

General Services Order Form

Site-City General Services ORDER FORM

Use this form to order any of our Site-City General Services such as pay advertising, banners, and other services! If you need web hosting or domain services then please use our "Web Hosting Order Form".

Describe Below What you want to order. Be sure to include price and total payment for Charge Orders, etc. Use this form for Pay Banner ads, Pay Classified ads, Pay Display ads and other items.

All Items In BOLD are Required!
Customer Information

Name:
Company Name:
Type of Business:
Address:
City:
State/Province:
Country:
Zip/Postal Code:
Daytime Phone:
Home Phone:
FAX:
Email:

Payment Method
MasterCard
Visa
Check/Money Order
(Site-City will process your order upon receipt of your payment)
Please remit Payment to:
Send this form with submit or Email to: WebStar Media or Postal Mail to:
Site-City Internet Services
%Cole
P.O. Box 399
Lubec, ME. 04652

Card#:
Expires:
Cardholder Name:

Where Did You Hear About Us?:
Search Engines
Direct Email
Our Website
Print Advertising
Other

Are you interested in becoming a dealer? No Yes

Thank you for using Site-City

General Services ORDER & Info Request FORM

Site-City General Services ORDER FORM

General Services
ORDER
& Info Request FORM