Payment Info
This form is exclusively for custom work on your website. The initial price to receive a bid is a non-refundable $200. If you accept the bid then the $200 will be credited toward the total cost of the custom work. If you choose to not accept the bid the $200 will not be refunded.

In the case that we decide that the custom work requested cannot be completed, then you will be refunded you the $200.

Name *
Current website license #
Phone number to best reach you *
E-mail to best reach you *
Requesting

	Navigation
	Graphic / Header
	Flash
	Specialized Product
	Other

Description
Please briefly describe what you are requesting.

Payment

		Visa
		Mastercard
		Discover
		American Express
	Card Number* Expiration* CVV(II)* What is CVV2?