EzySystems Ltd

Order Form

Please complete the following form giving full details where applicable. The form relates to the various products and services offered by Ezysystems and Lulworth-Online. Full details of our current offers and our terms and conditions may be found on our web site at www.ezysystems.co.uk

Product/Service reference:
Product/Service Description:
Company Name:
Registered Address:

		PostCode:
Daytime Telephone:
Fax Number:
Email Address:
Company Registration No.:
Numer of Employees:
Do you currently have a web site?		Yes No
If Yes, what is your domain name?
Please give a breif description of your company below:

How many products/Services do you currently sell?
Do you already have your own logo graphics?		Yes No
	Does your company take credit/debit card payments via a card authorisation unit (PDQ)?	Yes No
	Do you have access to a computer connected to the internet with which to add your products or services?	Yes No
	Are you able to provide digital images of your products if required by our designers?	Yes No
	Please give the name and contact number of the person responsible for driving this project within your organisation:	Name:
		Telephone No.
		: Email Address: