PC Madness Solution Source :: Solutions tailored for your business :: Remote Admin, Ecommerce, Web Design, Hosting, Graphic Design and Print

Website Design

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Please fill out your details below.
Whilst this form is not a binding contract, it does form the basis for one, so please fill out all information correctly.

If you are having difficulties submitting the form, please contact us, or download a copy and fax it to us on (08) 9250 4552.

1. Personal Details
* Denotes a required field - Your personal details will be held in strict confidence by PC Madness for the sole purpose of creating a Hosting Account and willl never be forwarded to a third party. View our full Privacy Policy.
First Name:*			Last Name:*
Business Name:			ABN:
Street Address:
Suburb or City:			State:		Postcode:
Email:*
Phone:*			Mobile:

2. Domain and FTP Details
If you already have a domain name, please enter it here. If you would like to have one registered, please enter your desired name and tick 'Yes' in the 'Registration Required' box. Charges displayed are only applicable if a new domain needs to be registered.
Domain Name:*
Registration Required?*	Yes	No
If you already have a Domain Name and Hosting account set up, please enter your login details. If you require a hosting account, please enter your desired user name and password and tick 'Yes' in the 'Hosting Required' box.
User Name:			Password:
Hosting Required?*	Yes	No

3. Web Package*
Please select ONE base option below:
Starter Package	1 Page Site			$399
Basic Package	5 Page Site, 1 Standard Form			$1199
Business Package	10 Page Site, 1 Standard Form, Domain Reg, 1 year Blue Hosting			$1799
Flash Package	Full Flash Site, 1 Standard Form, Domain Reg, 1 year Blue Hosting			from $2999

4. Extra Options
* Some of these options are only listed as a guide. A PC Madness Web Consultant will be in touch with you to discuss these options in more detail.
Extra Pages:	Extra Pages
Flash Content			Forms (A standard form is included as part of the Basic, Business and Flash Packages)
Flash Animated Logo:	Yes ($220)		Standard Online Form:		Yes ($149)
Flash Intro :	Yes (from $499)		Custom Online Form:		Yes (from $249)
Other Services
Online Shopping Cart:	Yes (Price available upon consideration of your individual requirements)
Photo Shoot:	Yes (Price available upon consideration of your individual requirements)

Other Comments:

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Terms and Conditions
‘Free Onsite Consultation’ refers to one initial onsite consultation - subsequent onsite callouts will be charged at the standard callout rate.
‘1 YEAR Included Hosting’ refers to one year of the PC Madness ‘Green Hosting Package’.
The use of the word ‘from’ in reference to the cost of ‘Flash Intro Movie’ and ‘Custom Online Form’ is representative of a general amount of work to be done. In special cases where this level of work is considered to be excessive, additional charges may apply. These additional charges will be discussed with the client prior to commencement of work.