PRINT THIS FORM OUT

REP#_____________

 

WEB SITE DESIGN, LINKING & HOSTING ORDER FORM


YOUR NEW WEBSITE ADDRESS WILL BE:

WWW.THEONLYDIRECTORY.COM/YOUR PHONE NUMBER

  
  
1.

BUSINESS DETAILS  (Fill Only Lines That Apply To Your Business)
The information that you provide us with will be put on your Web Page "as specified"
Please construct the sentences as you would like them to appear on your Web Page


TYPE OR PRINT LEGIBLY!

COMPANY NAME

____________________________________________

COMPANY ADDRESS

____________________________________________

CITY

____________________________________________

STATE

____________________________________________

ZIP CODE

____________________________________________

LOCAL TEL

____________________________________________

TOLL FREE TEL

____________________________________________

WHICH TELEPHONE NUMBER WOULD YOU LIKE VISITORS TO USE TO FIND YOU
(This is generally the phone number that you advertise to the public the most)

LOCAL NUMBER

TOLL FREE NUMBER

FAX

____________________________________________

EXISTING E-MAIL ADDRESS

____________________________________________

EXISTING WEBSITE

HTTP://_______________________________________

TYPE OF BUSINESS

____________________________________________

CONTACT NAME

____________________________________________

OWNERS NAME

____________________________________________

2.

IF APPLYING FOR A WEB LINK ONLY FROM THEONLYDIRECTORY.COM PHONE SEARCH TO YOUR EXISTING COMPANY WEBSITE PROCEED TO NUMBER < 5 >. OTHERWISE, CONTINUE WITH THE FORM

COMPANY BACKGROUND (e.g. years in business, locations served, services/products offered, brand name products used, warranty offered, any specializations, employee credentials, if serve customers in other languages - specify. Also, include if you offer flexible hours of service, any discounts, etc.)

(If you need more space for description, use separate sheet of paper)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

ARE REFERENCES AVAILABLE

YES     NO

FREE ESTIMATES

YES     NO

PICK UP/DELIVERY SERVICE AVAILABLE

YES     NO

EMERGENCY SERVICE AVAILABLE

YES     NO

CUSTOMER PARKING

YES     NO

HANDICAPPED ACCESS TO PREMISES

YES     NO

HOURS AND DAYS OF OPERATION

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

 

ANY LICENSE NUMBER/ACCREDITATION


____________________________________

INSURED

YES     NO

PAYMENT METHODS ACCEPTED
____________________________________

PAYMENT PLANS OFFERED

YES     NO

STORE GIFT CERTIFICATES AVAILABLE

YES     NO

PRICE MATCHING

YES     NO

ACCEPTANCE OF COMPETITORS COUPONS

YES     NO

COMMERCIAL ACCOUNTS

YES     NO



WOULD YOU LIKE YOUR WEBSITE VISITORS TO BE ABLE TO SEND YOU E-MAIL

YES     NO

WHICH EMAIL ADDRESS DO YOU PREFER TO USE TO RECEIVE THE CORRESPONDENCE FROM VISITORS

THEONLYDIRECTORY.COM  EMAIL ACCOUNT

OR SPECIFY OTHER   

HOW FAST WILL YOU RESPOND TO
E-MAIL REQUESTS

1 Hour     4 Hours     24 Hours     72 Hours


3.

PASSWORD SELECTION
(Website password is used when you send  a request to us to update your Web Page)

CHOOSE YOUR WEBSITE PASSWORD (Min. 6 Max. 10 Characters All Lower Case)

____________________

 

CHOOSE YOUR E-MAIL PASSWORD (Min. 6 Max. 10 Characters All Lower Case)

____________________

(YOUR WEBSITE PASSWORD MUST BE KEPT CONFIDENTIAL - DISCLOSE WITH DISCRETION)

Your E-mail and Website Login Name Will Be Your Primary Business Phone Number as Specified on this Application And Must Be Entered Starting With An Area Code and No Other Symbols. Example: 5086238912

4.

OPTIONAL WEB FEATURES 
YOU CAN HAVE ON YOUR WEB PAGE:

--- FEES ---

A) DRIVING DIRECTIONS ON YOUR WEB PAGE

YES   
NO

This Service is provided for free by "MapBlast!"

B) PRINTABLE WEB COUPONS

YES   
NO

$19.99 per each update

C) YOU ARE ENTITLED TO TWO DIGITAL IMAGES TO BE PRESENTED ON YOUR WEBSITE AT NO ADDITIONAL CHARGE. PLEASE CHOOSE ONE OF THE FOLLOWING:
(This is generally the outside and inside look of your business that you want your visitors to see.
Those could also be pictures of the owner and people who work at the place, examples of your work
 or any other visual representation) 


YOU WILL MAIL TWO PICTURES OF YOUR CHOICE TO US ALONG WITH THE PAYMENT 

YOU ALREADY HAVE THE PICTURES SCANNED (IN FORM OF COMPUTER FILE)
        AND YOU CAN E-MAIL THEM TO PICTURES@THEONLYDIRECTORY.COM 
        ((Please put phone number and  name of  the business in the e-mail's subject line))  

5.

CHOOSE YOUR PLAN (Check One)

   

A)  WEBLINK ONLY - If you already have a website and your Internet address is difficult to 
      advertise, this option will allow you to:  LINK TO YOUR EXISTING WEBSITE FROM 
      THEONLYDIRECTORY.COM "FIND WEB PAGE BY PHONE NUMBER" MENU  - $ 0.99 per month

 

       PLAN BS2279 EFFECTIVE FROM THE DAY OF APPLICATION TO 12/31/CURRENT YEAR 
      PLAN  INCLUDES 1(ONE) FREE PHONE NUMBER UPDATE

 

B)  COMPLETE PACKAGE: INCLUDES COMPLETE DESIGNED 1 WEB PAGE WITH 2 IMAGES 
       HOSTED AND MAINTAINED BY THEONLYDIRECTORY.COM WITH FREE 
       E-MAIL ADDRESS FOR WORLDWIDE ACCESS - $ 8.99 per month

 

       PLAN # BS2200 EFFECTIVE FROM THE DAY OF APPLICATION TO 12/31/CURRENT YEAR
       PLAN INCLUDES 1(ONE) FREE WEB PAGE  UPDATE

 

1(ONE) YEAR SERVICE COMMITMENT REQUIRED. THE CHOSEN PLAN MUST BE PREPAID IN FULL FROM THE DATE OF APPLICATION TO THE END OF THE CURRENT YEAR
TODAY'S DATE IS

   
6.

PLEASE ENTER THE AMOUNT YOU AGREED TO PAY UPON THE CHOSEN SERVICE PLAN
Take the number of months left in in the current year (including the current month) and multiply it by the monthly rate of the plan you have chosen

__$___________________________________

 

PLEASE NOTE: PRICES ARE SUBJECT TO CHANGE WITHOUT NOTIFICATION

READ AGREEMENT BEFORE SUBMITTING THIS FORM

------------------------------
TERMS OF SERVICE
By Submitting The Form:

* You agree to indemnify THEONLYDIRECTORY.COM and its affiliates, employees, 
agents and representatives, and to hold them harmless, from any and all claims and 
liabilities (including attorneys fees) which may arise from terminating any of the 
services provided by our partners, your submissions, information that will be 
published  on your site and hosted by us.
* You acknowledge that you are using the service at your own risk. The service is 
provided "as is" and the service provider and its affiliates hereby expressly disclaim 
any warranties, express or implied, including but not limited to any warranties of 
accuracy, reliability, title,  merchantability, non-infringement, fitness for a 
particular purpose or any other warranty, guarantee, condition presented in 
oral  or in writing/electronic form. 
* THEONLYDIRECTORY.COM has the right to terminate your ability to access 
the Service, for any reason, without notice. 
*You agree not to reproduce, duplicate, copy, sell, resell or exploit any portion of the 
Service, use of the Service, or access to the Service.
* The information, graphics and photos published at this Web Site could include 
inaccuracies or typographical errors. Additionally, we reserve the right to modify 
any material within this Web Site without notice. We make no commitment, 
however, to update the information contained in this Web Site.

7.

SIGNATURE                                                                                                   

By submitting this form you authorize THEONLYDIRECTORY.COM to provide you with the service according to THEONLYDIRECTORY.COM service agreement, the Schedule of Rates and Charges and the Terms and Conditions of service.


8.

AFTER YOU SUBMIT THIS FORM, MAIL THE PAYMENT & PICTURES TO:
(We Accept: Money Orders/Cashier's Checks/Business Checks)

THEONLYDIRECTORY.COM
210 Park Avenue, #256
Worcester, MA 01609

Copyrightę Theonlydirectory.com