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Order your Personal Website here!

You're only days away from being ONLINE with your own website!
Please complete the following information which we will use to
personalize your website. Once payment is received, we will secure your
domain name and begin personalizing your website.
(* Required Info)

Minor Website
updates / changes**
* Major website changes
can be requested
for an additional fee

**The included
'minor website updates'
covers basic changes
-such as email,
phone or address update;
text change on home page
or single Image change



After 1st year,
annual renewal prices
apply for domain,
website hosting and
basic maintenance
(Hosting Aprx. $160.00-175.00 annually, plus private
Domain Renewal fees*)









* Based on current pricing

Full Name: *
Email Address: * (For confirmation and follow-up)
Phone Contact: *
What DOMAIN NAME would you like to use?* (ie. www.YourDomain.com) Check available domain names
Do you currently own this Domain Name?*	Yes No
If NO, would you like us to secure and host this Domain Name for you? (1st Year FREE!)	Yes No
If you already own this Domain, where is your Domain Name currently hosted?
Website Template Choice (code): *  View Template codes & color choices	website choice Y101 Y102 Y103 Y104 Y105 Y106 Y107 Y108
Website Color Scheme choice: *	color scheme Blue Burgundy Green Khaki/Brown
Do you have a Photo, Logo or Image you would like included on your homepage?
Will you provide text for the home page of your website? *	Yes, I will provide text No, please use the default text
If you will be adding your own TEXT to the homepage, please type up to 3 paragraphs, (or note that you will Email separately)
Will your 5th page be an 'Individual Bio' page or an 'About Us' page? (please choose one)	Individual Bio Page About Us Page
Do you have a Photo/Logo to include on your Bio / About Us page? ( If so, please upload here)
Business Name to be displayed above address on your website: *  (ie. Equity One Mortgage)
Street / Mailing Address:
City, State, Zip:
Business Phone: *
Additional Business Phone:
Email address to be listed on your websites Contact Us page: *
Email address to which your client LOAN APPLICATIONS will be sent: *
Would you like your 'Contact Us' page to include a map and link to Driving Directions? *	Yes No
I have read and understand the User Agreement/Terms of Use: *	I Agree

Please Email any additional order information, such as Text &
Bio Information, Logos & Photos, or questions to:
info@YzVirtualDesign.com

Your personal website should be up and ready for use within just a few days.
Thank you for your order !