Order Form

If you're ready to order please use the form below to provide us with some basic information. Most of the questions are optional. As soon as we process your order (usually within one business day) we will send you a welcome email with more specific questions and information concerning your particular line of work or activity.
 

If you're not quite ready to order or just have more questions about this special, please give us a call (860 343-9381), send us an E or fill out this simple form and we will be happy to answer any questions you may have.
 
The total cost for this special is $499.00, a minimum deposit of $49.95 is required to get started.
 
* Required
* First Name      * Last 
 
Address  
 
   
 
City      State    Zip 
Phone       -   Use for Billing
 
Cell       -   Use for Billing
 
Fax       -
 
* Email  
What is the Best Way to Contact You? Phone  Cell  Email  Try All  
Domain
Name
Included *		    
Would you like us to register a domain name?  Yes   No
-or- Do you own a domain name you want to use? Yes   No
For More Information Please Contact Us by Phone or Email    (860) 343-9381    info@wired-web.com    Middletown, CT
 
 
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