B2B Design & Development LLC

B2B
Design & Development
610 Old Lancaster Road
Suite 200
Bryn Mawr, PA 19010
610-519-1830
Fax: 610-519-1831

We Now Accept the following credit cards
for your clients!

Contractor Info

*TR Rep Name:		Date:
Phone Number:		*Email Address:

URL Registration

Does your client need a URL (Web Address)?	YES	NO
Please CLICK HERE to check if the URL you want is available.
The URL I want is www. .
How many years would you like to register your URL for? ($21.00 year)
Would you like to register additional URLs?	YES	NO
If you answered yes, please check if they are available and add them to the notes at the bottom of the form.

Website Hosting

What URL do you want hosted?

www. .

Please check the hosting package you would like below:

Silver Plan: Up to 1000 Megs of space for $25.95 per month (includes up to 200 e-mail boxes)

E-Commerce Plan: Up to 750 Megs of space for $29.95 per month, ShopSite Starter Shopping Cart (includes 100 email boxe)

Value Pack Hosting: $60/mo. Includes: hosting, optimization & tracking, 4 hrs/yr. changes

Approximately how many email boxes would you like set up?

The following Client Contact Information MUST be filled out Completely
*Company Name:
*Contact Name:
*Address (NO P.O. BOXES):
*City:
*State:
*Zip Code:
*Phone#:
*Fax#:
*E-mail Address:


Paying By Check:
Paying By Credit Card:	Visa Mastercard Amex
Credit Card #:
Security #:	( Master Card, Visa - 3 Digits/ Amex - 4 Digits)
Expiration Date :	(mm/yyyy ie. 02/2005)

Notes

Please input the characters in the image below to the "Security Code" field to avoid spammers abusing this form.

Security Code :

*Some fields are required to submit this form.

B2B now accepts Visa, Master Card and American Express