Web Design Order Form

Use the following form for requests for website design and development. Please provide as much information as you can.

Customer Details
Business Details
Website Details
  1. I would like to order the following web design service:
  2. Custom Website Design priced from $ 250.00
  3. eCommerce Retail Website Development $ 390.00
  4. Basic WordPress Installation & Customisation $ 95.00
  5. Advanced WordPress Installation & Customisation $ 250.00
  6. I am ready to proceed with my new website:
  7. Yes - please send me an invoice so we can get started!
  8. Not just yet - I am making initial contact for further discussion
Website Details
  1. Website Business Name (if different from above):
  2. What will be the focus of your new website?
  3. E-Commerce / Retail Website
  4. Business / Information Website
  5. Portfolio / Photography Website
  6. Restaurant / Food Service Website
  7. Educational / School Website
  8. Blog / Forum Website
  9. What would you like your new website to achieve?

    For example, I would like to sell my products, I would like to provide information about my legal service, I would like customers to be able to view my gallery of artworks....

Hosting Details
  1. I have an existing web hosting account
  2. I will be purchasing web hosting with Mantra (new window)
  3. Note: Your website must be hosted with Mantra Web Hosting (us) if you choose our payment plan options for your website development. If your website is hosted elsewhere all website development costs are required to be paid upfront.
Domain Details
  1. I have an existing domain name
  2. I would like to register a new domain name (new window)
Preferred Payment Details
  1. Note: Your website must be hosted with Mantra Web Hosting (us) if you choose the weekly or fortnightly payment plan option for your website development. If your website is hosted elsewhere all website development costs are required to be paid upfront.
Optional Survey
Security Code
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  5. For security reasons your IP number has been recorded: 3.87.147.184