Web Site Order Form

First Name
Last Name
Company
Address
Address
City
US State or CA Province
Zip or Postal Code
Country
Day Phone
Evening Phone
Fax Phone
*** Primary E-mail Address
Secondary E-mail Address

Describe the site you want in the text box.

How will you promote your site? Important check one!!	Self Serve (e.g. click through to Traffic Boost or Submit It! from a L'Internet Communications page) Full Serve (+$25 per service) Using: Traffic Boost Submit It! Both Other Web Promtion service

Method of Payment:	Visa Mastercard Amex Mailing Personal Check