Victorian Shopping Mall Registration

The purpose of this form is to reserve your space and pricing in the mall. Space will be allocated on a first come-first served basis. You will be contacted by a representative once we receive your registration request..

Please provide the following information:

Name

Title

Organization

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

FAX

E-mail

Current URL

Please choose the package that you are interested in:

Package 1 $525 (includes site design)
Package 2 $375 (includes site design)
Package 3 $225/$275 with logo ( for existing sites, no design work)
Package 4 depending on website design

Please select the following main categories that apply (up to 2):(addt'l listings $75.00)

Services (Restoration)  Interior Design         Gifts & Crafts
                       
Fashion                 Decorative Accessories  Exterior

Additional comments:

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
Current URL