Trends 2000 Web Design Authorization Form

Please complete and read all provided information before sending... Your credit card is not billed by submitting this form. We will bill your credit card after we receive this agreement.

* Means mandatory required field

Web Design Authorization
Todays Date	*
Contact Name	*
Company Name	*
Full Address	*
City	*
State	*
Contact Phone	*
Email Address	*
How would you prefer to be contacted?		Email Phone Either
If you currently have a website, please supply the website address here
Will you need a domain name registered for your website?		Yes No
Will you need hosting for your website?		Yes No
how many pages you will need for your website?		Please Select 1 - 10 Pages 10 - 20 Pages 20 - 30 Pages 30 - 40 Pages 40 - 50 Pages 50 Plus Pages
What is your projected budget for this project?		Please Select $500 - $1500 $1500 - $2500 $2500 - $3500 $3500 - $4500 $4500 - $5500 $5500 - $6500 $6500 - 7500 $7500 - $10,000 $10,000 Plus
Are there any existing websites that closely match the functionality and/or design style you wish to have for your new website?		http://
Do you have any additional comments and/or requirements that you feel may be important?
--- Credit Card Information ---
Instructions: Please complete the information below:
Name as it appears on credit card	*
Address on credit card	*
City	*
State	*	- - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code	*
Phone Number	*
Credit Card or Payment Type	*	-- Choose One -- Amex Discover MasterCard Visa
Credit Card Number (No Dashes Please)	* No Dashes Please
Expire Month	*	- - Choose One - - Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Expire Year	*	- - - - 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
3 Digit Code on back panel of credit card. Amex 4 digits on right front of card (Business check enter 000)	* CVV code is on back right of card Amex is front right of card
Agreed Upon "Total" Fee From Bid Provided	*
Agreed Upon 50% Down-Payment	*
Agreed By (Enter Full Name)	*
GREAT OFFER!!! Become a Trends2000 VIP Club Member... When you become a VIP member we will build for you at no additional charge a "secured" ANTI-SPAM contact form and provide you with web page alterations/changes with no up charges! Value Added... Everything in our miscellaneous area as well. VIP Member - only - $169.95 monthly and a one-time setup fee of $199.00 . GET Details at [ http://bit.ly/an9rQX ] copy & paste url into browser.
Please Make a Selection Below: (Choose only one)
Yes		Yes Enroll me in the VIP CLUB for $169.95 monthly
Yes		Yes Enroll me in the VIP CLUB for $199 setup fee
No		No, I choose not to enroll at this time
Not Sure		Would like to discuss further
AGREEMENT: Please enter the agreed on "fee for service" below. We begin all jobs with a 50% down payment against the agreed fee with the balance due after 99% OF YOUR PROJECT IS COMPLETED. AT THAT TIME, YOU WILL RECEIVE FROM US, A WORK RELEASE-FINAL PAYMENT INVOICE, you will have (5) business days to proof your site for changes and submit those to us for final completion, at which time, (5 business days from the date on the WR-FP invoice), we will bill your credit card for the final payment for your web development project. Once your project is 99% complete you will receive an e-mail from us with the "PROOFING" domain for you to proof your site. Please keep in mind that your fee can increase if we are required to provide hosting and miscellaneous web services that have not previously been discussed. Also, if we need to purchase a web template for you, this cost will be added to your final payment as well. IMPORTANT: We do not provide refunds once work has begun. Also, by submitting this form you agree to our terms and are providing us YOUR AUTHORIZATION to bill your credit card card for 50% of the agreed rate listed below. The name that will appear on your credit card statement will be Nu-Rejime Plus Inc. our billing corporation since 1990. You also agree that we can link our web site to yours as your web designing company. Please note that we do not at any time retain any intellectual property rights to your web site, content or images. Your web site is your property and we are only involved to the extent needed to help you to establish your web presence.
VIP Member $199 One-Time Setup Fee (Not required):
VIP Member Monthly Subscription $169.95 (Not required):
Agreed Upon Total Project Fee from Bid	*
Agreed By (Enter Full Name)	*
Please enter "Security Code" as it appears with no spaces in the blank window provided	*
NOTICE: By submitting this form, the outlined agreements are binding and you are AUTHORIZING us to bill your credit card you have provided. We do not provide refunds once your credit card is processed and billed. The name that will appear on your credit card statement will be NU-REJIME PLUS INC. our billing corporation.