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Information  
Name:

Company Name:

VAT reg number: (if applicable)
ID number:

Tel Work:

Tel Mobile:

E-mail:

Physical Address:

Postal Address:

Terms and conditions :

  1. You agree to promplty pay the deposit of 50%.
  2. The full amount outstanding will be paid on completion of your website.

    I agree to the above terms and conditions

Please note that a deposit of 50% is payable upon submission of this form.  Details for payment will be sent to the e-mail address provided.