PBG Communications Ltd.

FREE WEBDESIGN / WEB HOSTING APPLICATION FORM

N 2,500.00 Only

For a free interactive website containing animations, text, graphics, online forms, web counters, etc. Complete the form below. Offer valid from Aug.1st - Nov. 31st 2007.

1. First Name:
2. Last Name:
3. Tittle: Mr. Mrs. Miss Others
4. Company
4a. Company Reg.No(for limited liability companies only)
5. Company Address
6. City
7. State
8. Current and functional email address(s)
9. Phone No(s)
10. Enter a Name for your new website in the right category. www. .nig-ltd.com (for limited liability companies) www. .nig-ent.com (for enterprises)
What kind of information would you like to have on your pages. *Please give us details or just briefly state the important facts if your answer to question number 11 is "yes".
11. Would you like us to help you develop texts and picture graphics for your website?
Yes No
11a. Home page:
11b. About Us
11c. Products
11d. Services
11e. Contact
12. Do you want an online request form for your new website? Yes No Click here to view our free basic online request form
13. What category of online form do you prefer? Basic(free) Custom(N15,000)
14. Are you interested in our free search engines registration offer? Yes No
14a. Submit my website to Google and 16 other popular search engines for N 7,740.00 per annum. as listed in page1. Yes No
15. Do you require a custom email? e.g you@yourbusiness.com Yes No
*5 customized email boxes, mail autoresponders or mailing list, costs N15,000.00/Year.
*For customized sevices please contact us for more details.
PAYMENT INFORMATION
Use the information below to make payments for your application forms: Our Bankers 1. Bank PHB : Account name - PBG Communications Limited. Account Number - 114102000021 2. Spring Bank : Account name - PBG Communications Limited. Account Number - 0571001003283
Give Details of your payments in the boxes below
Bank :
Branch:
Amount:
Teller No:
Depositor's Name:
Date:
I agree to the PBG Communications Ltd Terms of Service
DECLARATION
I declare that the statements made by me on this form are true to the best of my knowledge and belief, true and correct as I may be disqualified for any falsehood.
True False

#27 Ireakari Estate Road Isolo Lagos. E-mail: info@pbgcommunications.com Phone: 234-1-8140524, 234-803-312-8335.