Starter One Page Selection Form

Starter One Page Site Includes:

Domain Name registration
(example: www.mybusinessname.com).

One page company information web site design.

One full year of hosting.*

One email address or email forwarding account
(example: me@mybusinessname.com)

$99per year

Select Your Domain Name:
Web address you already own or would like to purchase for your site, included in the $99 per year price Click here if you have not yet checked to see if your name is available.
Select Your Web Site's Style:
Click here if you need to review the selection of styles.

Site Content
Fill out the information below and we will create your own one page website.
From the picture on the left, you can see where your text will be placed.
Don't worry about layout and spacing. Our designers will take care of the details.
If you need to separate your text into paragraphs, please place a ^ (Shift 6) at the beginning of each section.
Enter N/A (Not Applicable) in any fields that you don't wish to use, the form will not submit if any field is left blank.

Don't Forget to Check Your Spelling.

Site Name

Slogan
One sentence to be displayed below your site name

Headline
The first line of your site content

Optional Picture
Please send your picture in electronic form or contact our sales department for instructions at sales@jenica.com

Text
This text will be the main content in the body of your site

Contact Info
Where/How you want people to contact you (aside from your email)

Email Name
The name/text you want display for the email link ie Click here for information. Leave blank if same as email address.

Email Address
The actual email address (this site comes with your own email address, eg. info@mybusinessname.com)

Forward email to my existing email listed below in Order Information Section.

Company Info
Company, address, etc

Behind the Scenes (optional but recommended)
This information, though not shown to your visitors, will help them find your website.
We also have several web site promotion services available at economical prices.

Description
One or two sentences, stating a detailed description of what your website is about

Keywords
Twenty words and phrases relating to your site, best if in order of importance, separated with commas.
These are the mostly likely words that someone would type into a search to find your site.

Please select the category which best describes your website:

Customer Information

Email Address:
First Name:
Last Name:
Address:
City:	State: Zip/Postal code:
Country
Phone Number:
Best Time to Call:

www.mybusinessname.com is a trademark of:

10 Pine Street Extension Unit 80, Nashua, NH, 03060
Call us toll free at 1.888.642.6877 Tel 1.603.886.4668
Email: sales@jenica.com Fax 1.603.880.9209

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