MyFuneralWebsite.COM

Now that you have looked over our system and are ready to make your purchase, we need you to complete the form below. Please remember that fields marked with an asterik (*) are required fields. We have broken down the order form into sections for easier processing. You may find that as you answer a question a new section may appear for completion. Thanks for your order and a representative will be in touch with you shortly.

Primary Contact Information

Contact Person:

Phone Number:

Email Address:

Funeral Home Name:

Physical Address:

City:

State:

Zip Code:

Do you own a Domain Name for your Funeral Home?
Yes No

If yes, what is the Domain Name? (www.yourdomain.com)

If no, can you provide us with a domain name that we can look up for availability?

Does your Funeral Home have multiple locations including either same or different names or satellite offices?

Additional Location #1

Funeral Home Name:

Physical Address:

City:

State:

Zip Code:

Do you require a Domain Name for this location?
Yes No

If YES, what is a Domain Name that you would like us to check?

If NO, could you provide the Domain Name you are using:

Additional Location #2

Funeral Home Name:

Physical Address:

City:

State:

Zip Code:

Do you require a Domain Name for this location?
Yes No

If YES, what is a Domain Name that you would like us to check?

If NO, could you provide the Domain Name you are using:

Additional Location #3

Funeral Home Name:

Physical Address:

City:

State:

Zip Code:

Do you require a Domain Name for this location?
Yes No

If YES, what is a Domain Name that you would like us to check?

If NO, could you provide the Domain Name you are using:

Product Selection

Product Type

Projected Launch Date (mm/dd/yyyy):

Designer Series Templates:
(click here to view the designer series templates)

We will require your logo to be added to your design. You can either have your printer send the logo or scan in your letterhead if it is only script font. If you feel that you are ready for a Logo Enhancement, check out our Logo Development option.

You can email your logo to info@frazerconsultants.com.

Easy Pay Hosting & Support

Please select the Standard or Premiere Easy Pay Fee.

Easy Pay Standard

Limited support (8:00 - 5:00 CST email only)
Update content on your own
25Mb Hosting
5 email accounts

Easy Pay Premiere

Priority 24x7 support (Phone, Instant messenger, Email)
Includes content updates
50Mb Hosting
Unlimited email accounts

Standard:

Premiere:

Additional ServicesPlease check mark any services that you would like to have added to your order.

Content transfer from existing web site:	($149.95 for 15 web pages)
Transfer existing death records from existing web site:	($249.95)
Additional Domain Name(s):	($75.00 for 3 years)
Logo Creation:	($1995.00, includes stationery design)

Order Conclusion

We are requesting that you provide us a Username/Password that you would use to login to the administration system. Please remember that passwords should contain both numbers and letters to maximize the security.

Requested Username:

Requested Password:

If you had a distributor partner representative contact you before your order, please provide their name below:

Sales Rep Name:

To conclude your order, we need you to select your payment method for the One time setup fee, Easy Pay Fee and any additional services that you selected.

Select Your Payment Method:

By submitting your order, you have acknowledged that you have read and understand our terms and conditions agreement.