Your personal name: Trading as name: Address: Town: City: Post Code: Telephone: Public E-mail (the one every one can contact you with): Services provided, you can add more later: A short message about your services, to get your site going: Paying by card, enter type, Visa, Master, etc: Issue Number SWITCH ONLY: Card Number: Card Security Code, last three digits in signature strip: Starts: (mm/yy) and Expires: Amount 50.00p.a. For a Deluxe website on our server, for 50 per year. Price includes maintenance and updating as you require. Optional Domain name add 70 for two years registration (35 per year, no registration fees). We will debit your card once the basic site has been uploaded. This is for the first year. Take a print out of this page for your own records. Email this form to You can pay by card over the phone 01792 229191 Tuesdays to Fridays 9.30am till 1.00pm Or post with your cheque payable to Galaxy Studios The Weddings in Wales Website Galaxy Studios 78 High Street Gorseinon Swansea SA4 4BL