Language
English (US)
Chinese
Website Order Form
(English Version)
Customer ID#
Agent Name:
*
Name
*
First Name
Last Name
Owner Cell #
*
-
Area Code
Phone Number
Email
*
example@example.com
WeChat ID
BUSINESS NAME
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
*
-
Area Code
Phone Number
Website Base Package
*
Base Package $199
Date
/
Month
/
Day
Year
Date Picker Icon
Add On Service (Optional)
Alert Pop-ups $50.00
Coupon/ Activity $50.00
Social Media Account $50.00
One Click Contact $50.00
Testimonial $50.00
Blog $100.00
Career Form $100.00
Countdown $100.00
Reservation Form $100.00
Event Calendar $100.00
Self-Content editing $300.00
Website SEO $300.00
Franchise Page (show multi-locations info, map, menu ($50/location), and Franchise Application) $300.00
Social Media Account Signup ($50/Account)
Facebook
Yelp
Google
Instagram
Twitter
Other
Photoshop Service ($10/Picture)
# of Pictures
3rd Party Online Order ($25/Linik)
# of link
Add-on Service Total
Domain/Hosting Service
Website Annual Hosting Fee
*
Annual Hosting Fee - $250/Yr
Total Due
Payment Information
Amount Due Today
Monthly Subscription Due
Annual Subscription Due (Next Year Today)
Name
*
First Name
Last Name
Name on Bank Account (Business name if used)
*
Billing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
State
Zip Code
Bank Name
*
Bank Routing Number
*
Bank Account Number
*
Type of Bank Account
*
Personal checking
Personal Saving
Business Checking
Business Saving
Signature:
Name
*
First Name
Last Name
Date
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Note:
Submit
Should be Empty: