Design: [r_pages] pages
HTML: [designtotal]
Flash \ Java: [< [flashtotal] >] 		Hosting:
[< [webspace] >] Per Mo.
Monthly Fees: [monthlytotal] 		Domain:
[domain] For 2 Years
Monthly Prom: [marketing]
 		Features:
Forms: [formtotal]
Others: [< [extrastotal] + [carttotal] >]
Current Total:  $[< ( [flashtotal] + [formtotal] + [designtotal] + [domain] + [extrastotal] + [carttotal] ) * [help] >] plus $[< [webspace] + [audiovideo] + [livehelper] + [cartprice] + [marketing] >] Per Month      Domain:  [domain2]




3. Personal Information:
 Thank you for your interest in BCSdesign. Required fields are marked with a *
Name *
Company
E-Mail *
E-Mail Validation
Daytime Phone
Evening Phone
Address *
City *  State *


Pre-pay 12 months for your [webspace] per mo. web hosting and save the [< [webspace] * 2.5 >] setup fee:
Only applies if ordering server space through BCS.
Yes   No



Desired 8 Character Password: *
Enter the password you would like to use for your account:



Would you prefer that we contact you by: *
E-mail    Evening Phone



Additional Comments: Please describe the site you have in mind or any special features not covered previously.