CUSTOM ONLINE FORM Order Form

We can custom design any of over 25 different types of forms to capture information that will be sent right to your email address! In 2-4 business days after payment is received, you'll be given the link to your new form. Simply install it on your webpage. There are no additional fees to host your form.

PLEASE READ EACH ITEM CAREFULLY. Items marked with a red asterisk are required fields.

Basic Custom Online Form -- $29.95 (one-time design fee)

SAMPLES: www.insidersecrets.info/sampleforms.htm

~ 5 fields
~ text header
~ submit button can be linked to a webpage if you need to redirect people somewhere after they submit the form
~ 1 round of revisions

Type of form we will create for you:

Here are some of the forms we can create:

Application Forms
Appointment Forms
Booking/Reservation Forms
Consent Forms
Contact Us Forms
Donation Forms
Employment Forms
Evaluation Forms
Feedback Forms

Lead Generation Forms
Medical Forms
Membership Forms
Order Forms
Quote Forms
Payment Forms
Recommendation Forms
Registration Forms
Reservation Forms

RSVP Forms
Report Forms
Request Forms
Signup Forms
Sponsorship Forms
Surveys / Polls
Tracking Forms
Upload Forms
Volunteer Forms

Where will your form (link) be installed ?

Company Name

Phone Number*

Area CodePhone Number

Cell Phone:

Area CodePhone Number

Fax

Area CodePhone Number

Tollfree

Area CodePhone Number

Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Company Email*

Email address you want your form results to be sent to*

Company website

Field #1 that you need on your form

Field #2 that you need on your form

Field #3 that you need on your form

Field #4 that you need on your form

Field #5 that you need on your form

Where do you want to send the person to after they hit the submit button?

Additional fields are $1.95 each. Please enter any addtional fields you need:

Add a photo, logo, etc. to your form for just $4.95 each.

URL of your high-resolution quality logo or photo (must not violate any copyrights)

Or upload your image to us here

Upload a File

(See our upgrades below if you'd like to have us design a professional logo for an additional fee.)

URL's of any additional images you want on your form

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Upload a File

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Upload a File

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Upload a File

Any color preferences? (we’re planning to use colors that compliment/match your logo and/or desktop website.)

Your theme choice:

Questions/Comments

NOTE: Your form will have this small credit line at the bottom:

Form Designer

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(Costs will be emailed to you in a Quote, approved by you in advance, and billed to you upon project completion)

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Creating editable QR Codes with tracking – see samples at www.insidersecrets.info/qrcodes.htm for details.

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Offer any file for your users to download (PDF, DOC, images, etc.) – optional: require user to register before being able to download the file

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Graphic design

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Creation of company logo -- starting at $189. See www.insidersecrets.info/logodesign.htm for details.

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Photography

Other

We offer over 30 business services! Click here for details.

Explanatory notes describing your needs

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Name of Authorized Company Representative Placing this Order

Payment for the Basic Package is due prior to submitting this Order Form. If you have custom quote work done, those fees will be approved by you in advance and billed at the end of the project, along with any other balances. Final invoice charges will be due within no later than 3 business days from invoice date.

To pay electronically and instantly, click the BUY NOW button to go to our secure online payment area ... we accept PayPal, Visa, MasterCard, Discover, and American Express. (We will not see your credit card or personal information. PayPal securely handles the transaction for us.)

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I HAVE SENT PAYMENT FOR THIS ORDER*

yes

Amount Of The Payment I Sent*

Payment Date*

Payment Method I Used*

credit cardPayPalcheckcash

PLEASE BE SURE TO RETURN HERE AFTER MAKING YOUR PAYMENT TO COMPLETE THE ORDERING PROCESS (CLICK THE "SUBMIT" BUTTON BELOW!)

Enter the message as it's shown*

CUSTOM ONLINE FORM Order Form

UPGRADES

PAYMENT INFORMATION

FINAL STEPS