Order Form

Required General Information

Please use the tab key or mouse when entering data into form, the enter key submits it prematurely!

•  Please provide the following contact information:

  First Name
  Last Name
  Middle Initial
  Title
  Organization
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Country
  Work Phone
  FAX
  E-mail
  URL (if  applicable)

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Licenses & Graphic Design Services 

• Select the type of Graphic Design Service you are requesting.

     Custom Graphics Design License Existing Graphics  Scanning Services

For Scanning Services please email orders@divwebdesigns.com for further information.

•  What type(s) of graphics are you licensing or ordering. Select any of the following options that apply:

  Theme set        Photo/Clip Art  Animations      Backgrounds   
  

•  Please provide the following information:

  QTY	Description and Color of Graphic --

  	SHIPPING(if different from above)
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Country

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Web Design Services Only

•  Are you using a Theme Set from Divine Web Graphics?

  Yes No
  

•  If yes, what is the name or description of the Theme Set?

•  Enter your background color number and  name.