Webpage Order Form

1. Fill out this form.
2. Ensure you complete your Visa Card, Mastercard or American Express details at the bottom or send a cheque for the correct amount payable to Kalgola Pty Ltd at Walkabout Travel.
3. Print it out.
4. Sign the form.
5. Fax it to (02) 4232 1837 from within Australia OR
6. Mail the information to Walkabout Travel, G.P.O. Box 249, Sydney, NSW 2001.

• We will fax, mail or email a copy of the page when it has been created.
• Please create a home page for my
Motel Hotel Guest House Bed & Breakfast Farmstay Caravan Park Resort Restaurant Cafe Tourist information office Other (please specify):

Select a template for your webpage:
Template 1 (see example)
Template 2 (see example)

Name:
Name of Organisation:
Street Address:
City
State:	Postcode
Telephone:
Fax:
Email:
Information Provided:
Tick the appropriate boxes. If you tick 'I need assistance' we will contact you in the next three days. Logo Attached I need assistance Photographs Attached I need assistance Description of the product including rates/charges and features Attached I need assistance
Payment Please select a subscription: $330 - for 6 months ($110 once-off for webpage, $55 per year maintenance, $165 per 6 months connection fee) GST included. $440 - for 12 months ($110 once-off for webpage, $55 per year maintenance, $275 per year connection fee) GST included. Please find a cheque enclosed payable to Kalgola Pty Ltd for the above amount OR Please charge my credit card
Card Type:	Visa Mastercard American Express
Card Number:
Name on Card:
Expiry Date:	/
Cardholder Signature	_____________________________