Website Design Application Form
Login Information
Username: Password:
Hint Question Hint Answer:
Personal Details:
Company Name: Title:
Name: Surname:
ID/CO Reg no.: E-maii:
Postal Address: Physical Address:
Address: Address:
City: City:
Province: Province:
Code: Code:
Contact Details: Payment Details:
Tel (w): Cash:
Tel (h): Debit order: (optional)
Fax (w): Account Holder:
Fax(h): Bank Name:
Cell: Branch Name:
    Branch Code:
    Account Type:
    Account Nr:
  Webdesign Packages + Added extras
  Description:   Setup / Once Off
1. 5 Page Website   R2900
2. 10 Page Website   R4800
3. Additional Pages   R350
4. Information Forms

5. Static header/banner design

6. Online Booking Forms   R750
7. Picture Gallery (Max 10 Pictures)

8. Opening to New Page or Popup   R50
9. Maintenance per hour   R350
10. Hit Counter   R300
Terms and Conditions :


Accept all Terms and Conditions.
By submitting, I agree to all terms and conditions.