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:
 
 
Daytime Telephone:
Fax Number:
Email Address:
Company Registration No.:
Numer of Employees:
Do you currently have a web site?
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?
  Does your company take credit/debit card payments via a card authorisation unit (PDQ)?
  Do you have access to a computer connected to the internet with which to add your products or services?
  Are you able to provide digital images of your products if required by our designers?
  Please give the name and contact number of the person responsible for driving this project within your organisation: