TOGETHER AGAIN
Personal Web Page Design

Please complete all sections of this form and click submit at the bottom. Once payment is received, the web page will go "live" and you will be contacted via email with the address to your web page and other particulars.
Incomplete submissions will not be processed

 

      

 

 Enter Title of your Web Page

 
 

 Choose a text colour

(default is white)

 
 

 Choose your background - remember to consider the text colour you choose

 
 

 If you want people to be able to email you, please enter your email address

(format: email@email.com)		  
       

 Enter a personal note you want displayed on your web page
 

Pictures for your Web Page:

You can post 1 or 2 pictures on your web page. Please mail the pictures with your payment. They will be returned to you. If you have scanned pictures for use on the web page, please email them in an attachment to webpics@pweck.net

 Personal Info (all sections required)

Name:

Address:

City:

State:

Postal Code:

Phone:

- -

Email Address:

(email@name.com)

Together Again Reference Number:

Payment for the web page is a one time fee that will cover the costs of designing the web page. We will host the web page for as long as you wish, and at any time you may cancel the web page or have the option of moving it to another address. Please send payment to:

Dean Lodge, 2106 Nottingham Ct, #6 Council Bluffs, IA 51503
(checks/money orders only - payable to Dean Lodge)