ONLINE BRITAIN - Ordering your domain name

Please complete all boxes with a * even if you enter n/a.
If you need to add more to the information you have provided in any of the lines, please use the additional information box at the bottom of the form.

*This section is about you, and your contact details - we use this information to contact you*
*Your name (in the format Mr John Smith):
*Your contact telephone number (landline) :
Your contact telephone number (mobile) :
*Your contact email address :
*Confirm your contact email address :
*Your contact postal address :

*Town :
*County :
*Postcode :
The following information will be displayed on the contact us page:
*Name :
Company address :

Town :
County :
Postcode :
Telephone number : (also used on the bottom of every page)
2nd Telephone number :
Mobile Telephone number :
Fax number :
Email address : This should be an email address at your website e.g.info@mydomain.co.uk
This section is about customising the website to your business, and supplying the content
*Enter your chosen domain name :		www. .co.uk
*Principal colour to be used on website : This will be used for main headings, etc.		e.g. light blue, or dark green
*Accent colour to be used on website : This will be used on email links, etc.		e.g. bright red, or orange
*Text colour : This will be used for the main text content of the webpage		e.g. dark green, or black
*Background colour : This will be used as the background colour of the webpage		e.g. cream, or white
*Page Heading for first page : this is for the navigation bar button
*Page content for first page :		email to new-content@onlinebritain.co.uk
*Page Heading for second page : this is for the navigation bar button
*Page content for second page :		email to new-content@onlinebritain.co.uk
*Your company logo : We can use your company name in words, instead		email to new-content@onlinebritain.co.uk
*How will you send the pictures to Online Britain? :		email to new-content@onlinebritain.co.uk
Additional information : Use this additional information box to provide any information which you coudn't include above, or where you need to give us any extra information.

Please complete all information with an asterisk () before sending the form.*

It would help us if you *could tell us where you heard about Online Britain*
How did you hear about Online Britain? :

To complete the form, please re-enter your chosen domain name below to confirm that you accept the Online Britain Terms & Conditions, and click the Submit Order button www. .co.uk

If your requirements are for something more than our 3 page website, please give us a call.
Online Britain is part of Image Website Design, and we will be happy to discuss modifications and extra's.
Image Website Design are experienced designers of bespoke brochure websites, and your website can be tailored to suit the needs of your business.

ordering your 3 page website