E-Order form

Business details

Business name: Sales consultant: Contact name: Contact email: Contact tel: Mobile tel: Contact address: Billing address (if different from above): Company reg number:

Order details

Product	Price (ex. VAT)






Sub-total
Authed
Total

Payment options

Payment option

Balance

Paid on the day	To pay in 7 days	To pay in 90 days
Setup fee (33.33%)	Initial payment (33.33%)	Balance (33.33%)

Monthly payment	Total to pay
	£

* 1 month's notice is required for any cancellations of PAYG payment terms

Initial payment	Inital payment date	Balance paid over	Monthly payment	Total to pay
				£

Monthly payment	DD Payment day	Total to pay
		£

* 1 month's notice is required for any cancellations of PAYG payment terms

Initial payment	Inital payment date	Balance paid over	Monthly payment	DD Payment day	Total to pay
					£

Special payment terms (please detail breakdown of payments and schedules)

Product information

Upload logos / images / content

Website

Domain name: Website Notes

App

Company colours

Colour 1:

Colour 2:

Colour 3:

App navigation position

Bottom (scroller)

Bottom (more button)

Slider (list)

Slider (tiles)

App features

App keywords (To be shown in the app store, max 100 characters) App description (To be shown in the app store) Other App Notes

Complete your order

Thank you for placing your order. By signing this order you are agreeing that you have received and read the terms and conditions and that you have relevant permissions for any imagery and content, you will be solely liable for any breaches of copyright, trademark or any other infringements. This order form serves as a record of your purchase. We reserve the right to cancel or amend any orders should any errors be made at point of sale, should this happen you will be notified via telephone and in writing.

I agree I have read the terms & conditions

Customer signature:

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Name: Position: