eGiftBaskets.com Inc
8950 W. Olympic Blvd Suite 126
Beverly Hills Ca 90211
Info@eGiftBaskets.com

Please print out this page and fax it back to us at (302) 258-1000

Billing Information
Full Name:
Phone: Email:
Address:
City: State: Billing Zipcode:

Credit Card Information
Credit Card Type: VISA | Mastercard | AmEx
Credit Card Number:
Expiration Date:    _______ / _______ Security Code:
Authorization Signature: Date:

Order Information
Package I - Bronze Package
Package II - Silver Package
FTP access for your website - $35
Domain name registration - $30
FTP access for your website - $35
Backup CD for your website - $45
Reminder Service - $149
Discount/Promotional Codes - $199
Package III - Gold Package
Package IV - Platinum Package
Client logins - $199
5000 full color business cards - $295
5000 full color postcards - $495
5000 full page color flyer - $995
10,000 websites hits - $299
Monthly Hosting - $19.95/$23.95/$24.95/$29.95/$39.95

By signing above, I(We) ______________________________ give eGiftBaskets.com permission to charge my credit card or checking account the total amount described on this order form for the services. I fully understand and accept Egiftbaskets.com NO REFUND POLICY of any and all charges. I further understand and agree that any monthly hosting fees associated with my purchase will be charged to my credit card or checking account on the first business day of every month. I fully agree and accept that I may cancel my service with eGiftBaskets.com at any time, but will receive no refund of any monies paid to egiftbaskets.com prior to the date of cancellation. Privacy Policy

Total cost for Gift Package Site $_____________________

Monthly hosting Charge $___________________________

Signature__________________________________ Date:___________________