ORDER FORM FOR NEW MOBILE WEBSITE Please note that all fields of this form must be filled. Please make all checks payable to CyberGateways Inc. If you don't have your own website yet and you need it along with your mobile website, please visit our main web development website where we offering expert services in custom website and application development, web design, search engine optimizations, online reputation management and Internet marketing BUSINESS NAME * A - CLIENT INFORMATION Address * City * State * ZIP * Business Phone * Full Contact Name * Email address * Website * B - PACKAGE DETAILS Estimate Launch Date * Estimated date of completion should be minimum in 7 business days from the day of this Order Form Submission Initial Payment Design, Programming, Installation and Domain Setup fee - $299 Monthly Hosting, Maintenance and Backup fee - $29 (after the first free month) Total Intial Payment for New York State residents - $325 Total Initial Payment for non-NYS residents - $299 C - PAYMENT SCHEDULE Your service plan consists of an initial setup fee of $299, plus tax and monthly dues of $29, plus tax. The monthly amount will be collected on the first day of each month (after 30 days free), using the payment method supplied above. Payment Type * PayPal Visa MasterCard Discover AmEx PayPal Account Details Enter Email address associated with your Paypal Account * D - CREDIT CARD DATA Credit Card Number CCV2 Code Name on Card Expiration Date Please Confirm I agree with Terms and Conditions and allow Cyber Gateways Inc. to charge my Credit Card Initial Charge above and monthly fee of $29 PROVE YOU ARE HUMAN Type the characters shown below: * Click on Code image if you need to refresh This field should be left blank SUBMIT AGREEMENT Please wait...
