LOYALTYMATTERS WEBSITE ORDER FORM WEBSITE ORDER CONFIRMATION FORMPlease use this form to confirm that you would like us to proceed with the design and build of your website.Estimate Number (if applicable):Project NameYour Name* First Last Business NameEmail* Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Today's Date*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Final (live) URL FOR THE WEBSITETarget Completion Date DD slash MM slash YYYY YOUR ORDER CONFIRMATIONI confirm that we would like you to proceed with the design and build of our website as per your proposed summary of investment.* I confirm In addition to the website, we are interested in the following optional services. Please contact me to discuss options and fees.Please tick all that apply. Content copywriting Digital (page turning) brochure hosting Email marketing Graphic design (for brochures, stationery etc) Ongoing marketing support (consider us as part of your team for an agreed fixed price monthly fee) PPC advertising (Google, Facebook, LinkedIn etc) Printing services Search engine optimisation (SEO) Setup of website conversion tracking and remarketing campaigns with Google, Facebook & LinkedIn Social media marketing Thank you! We will follow up with you to chat through packages and the implementation of these in our briefing / design / build phases..I can confirm the following with regards to website hosting, post build:* I would like LoyaltyMATTERS to host the website & provide daily backups I intend to host the website myself and need you to provide a copy of the final approved version of the website and database ready for us to install on our own or a third party server (I understand your 12 month guarantee will no longer apply) I would like you to install the website on our own or third party servers (I understand additional fees are payable and your 12 month guarantee will no longer apply) You have indicated that you want us to host your website. Do you require any of the following services? Email (mailbox) hosting - £3.50 per mailbox per month Ongoing maintenance / support of my website, after launch - from £25 per month SSL certificate (green padlock) - £25 per quarter I understand that your website proposals are based upon an estimated number of hours and that you include an allowance of up to 10% additional time within your fees. In the event that timings exceed the estimate +10%, I understand and accept that additional fees may be payable, subject to these being discussed and agreed with me in advance.*Please tick to confirm that you agree. I agree I agree, acknowledge and accept that, unless we ask you to write the copy for the website, it is our responsibility to ensure the copy and images that we supply do not breach any copyright infringements.*Please tick to confirm that you agree. I agree YOUR WEBSITE ORDER APPROVALYour Purchase Order Number (If Applicable)Your Name*Your eSignature*I (the client) am authorised to complete this form. I understand and acknowledge that an electronic signature constitutes a legal signature and that in signing this agreement I accept and agree to loyaltyMATTERs terms of service. Please tick to confirm the statement below I (the client) am authorised to complete this form. I understand and acknowledge that an electronic signature constitutes a legal signature and that in signing this agreement I accept and agree to loyaltyMATTERs terms of service. CAPTCHA