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CALL: Germany #: (49)
If you would like to contact me before sending a work request,
please call the number above and I will gladly answer any
related questions you may have.
                                 Company Name (if any):    
                                          Your Name:                 
                                          Your Phone #:               
                                            Your Fax #:                
                                          Your Pager #:               
                                        Your Cellular #:              
                                     E-Mail (please verify):           
                          Your Mailing address:               
                         Your Physical address:               
                                             Web Site Address (if any)                
                         Please select one:                  
  FastShop - all Products with Shopping Cart here on one Page. 
                I will be providing:                  
My web site hosting will be done:  
URL of sample layout I like (Optional):  
My Search Engines are (hold CTRL-key for multiple choices):   

Please remit payment as U.S. Postal Money Order (P.M.O.) or Bank Cashiers Check (B.C.C.) to:

Richard Young

Below you can explain in more detail what you desire
(ie., custom requests, purpose of web site,
scanning service, or request more information, etc.).

This purchase order is subject to the UmpquaInterMall.com’s
Terms of Service (TOS) and is as such a legally binding contract.
Our TOS may be viewed at our Website. A printed copy of the
Tos is available by written request (10-pages), Please remit S.A.E.
plus $ 5.00 as P.M.O. or Check for postage & processing.
All Sales are final, no refunds. Other contracts are required for
Domain Registrations (two year minimum). All Display products are
for one year minimum & renew automatically as per our TOS.
Checks are subject to prior bank clearance.

Comments or description of services to perform:

 

Comments:



You are under *obligation"by completing this form!
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Last revised: August 16, 2010.