"Your Directory for LOCAL Businesses"
WEBSITE/PAGE ORDER FORM

Please complete this form and return to us via e-mail or "snail" mail (address below)

YES! I want to have a website/page under "Western Pennsylvania Business.com"!

Your Name:
Business Name:
Name on Web Page:
Type of Business:
Email:
Address:
Address:
City:
State:
Telephone:
Fax Number::
This order is being placed for the following items:
Mini Webpage Hosting and Design @ $50..00/yr
Website/Page Hosting and Design @ $100.00/yr
Please contact me regarding a flat fee for multiple changes throughout the year
We will contact you for the information you want on your web pages.

Terms: Payment in full is due upon receipt of the e-mail invoice sent to you upon activation of your website.
Before submitting, click Here to read User Agreement

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Gumpp Web Design Services

191 Gumpp Drive
Slippery Rock, PA 16057
(724) 530-7191
Email: Info@WesternPABusiness.Com

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