One page Website Design Order Form

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ONE PAGE • WEBSITE DESIGN ORDER FORM
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Name* This field is required.
First Name
Last Name
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Company / Organization Name* This field is required.
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Phone Number* This field is required.
Area Code
Phone Number
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Email* This field is required.
example@example.com
7
Are you registered?* This field is required.IS YOUR COMPANY REGISTERED ( LLC OR OTHERWISE ) ON OR BEFORE THE DATE OF THIS ORDER FORM?
YES
NO
I Don't Know
N/A
8
Describe your business:* This field is required.Give us a brief description of your business\organization and the services and or products you provide.
9
Social Media* This field is required.Please list all active social Media accounts you want listed on your website.
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Do you already have a website we are revamping? Or are you starting your web build from scratch?* This field is required.
Revamping current website
Starting New website Build
Not Sure
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What platform would you like your site built on?If you honestly do not know we can decide for you. Google both and compare if you want additional information between the two platforms.
Wix
Shopify
Whatever we suggest
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Do you already have any of the following purchased?* This field is required.
Website domain
Website hosting
Both
None
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Which of the following will this site be classified as* This field is required.
Service Only
Selling Products Only
Service and Selling Products
Blog
All the Above
Other
Not Sure
14
Would you like SEO's set up for you?* This field is required.
Yes
No
I Don't know Yet.
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If you answered yes to the previous question please list all tags below.* This field is required.If no please type N/A
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Do you need a biography created for your company?* This field is required.If you do not have a Biography we can create a professional clean and detailed biography just for you! All we need is a little information about you and\or your company in a quick questionaire for a small fee ($35) we would have a pristine bio perfect for your site! Is this something that you are interested in doing?
Yes
No
I Don't Know
17
Upload additional information for your website.* This field is required.( return policy, FAQ, incentives etc.)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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List All Information you will want on your one page website AND the information to be listed under each.* This field is required.Example : HOME, ABOUT, SHOP, FAQS CONTACT (((THIS IS A BLUE PRINT FOR US SO THAT WE KNOW HOW TO CONSTRUCT YOUR MAIN PAGE APPROPRIATELY. PLEASE COMPLETE THIS PORTION AS ACCURATELY AS POSSIBLE!!!)))
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Upload all images/documents to be used on the website. * This field is required.If your images are too large or you have more then what will fit in the upload panel please EMAIL THEM TO MEDIAGPX@GMAIL.COM WITH YOU COMPANY NAME IN THE SUBJECT LINE!!!!!
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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List any example websites you would like for us to reference as a guide in building your website design. * This field is required.
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Any additional information we may need for the website? * This field is required.
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RUSH OPTIONS

IT IS YOUR RESPONSIBILITY AS THE BUYER TO SUPPLY THE DESIGNERS WITH ALL IMAGES AND CONTENT FOR YOUR PACKAGE AND/OR SERVICE ORDERED. THE LONGER YOU TAKE TO SEND YOUR CONTENT THE LONGER IT TAKES FOR THE DESIGNERS TO CREATE IT! PLEASE KEEP THIS IN MIND WHEN RUSHING ALL ORDERS.
YOU CAN SELECT THE RUSH OPTION AT CHECK OUT AT THE END OF THIS FORM!
RUSH FEE ON ALL WEBSITES IS $150

FOR A 24 HOUR

TURNAROUND WEEKENDS ARE NOT INCLUDED
(TIME CAN VARY DEPENDING ON CLIENT ABILITY TO PROVIDE ACCURATE INFO NEEDED AND WORKLOAD AT TIME OF ORDER)

ABSOLUTELY NO REFUNDS ON RUSH FEES!
23
You must agree to Media GPX terms and conditions in order to proceed.* This field is required.
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Please Sign your name below for authorization purposes.* This field is required.
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My Products
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Quantity:1
Size:Small
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ORDER SUMMARY
Tax:USD
SubtotalUSD
Total costUSD
One Page Website Design FULL PRICE
$600.00+Edit
Back
One Page Website Design DEPOSIT ( NO SALE DISCOUNT ON DEPOSITS! )
$300.00+Edit
Back
Construct A Biography
$35.00+Edit
Back
Rush It!!
$150.00+Edit
Back
Total cost $0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
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February
March
April
May
June
July
August
September
October
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Expiration Month
2023
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
Expiration Year
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
26
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