Web Page Application

We will need the following information to set up your Web Page. Please note that the Items in Red are required. The items in Black are optional. 


Please provide the following contact information:

            Name 
     Fleet, Cab# 
  Street Address 
Address (PO Box) 
            City 
  State/Province 
 Zip/Postal Code 
      Work Phone 
      Home Phone 
             FAX 
          E-mail 

Please select one of the following options:

Smoking    Non-Smoking

Do you have a child seat ?

Yes           No

How many child seats do you have ?

What languages do you speak?

Which credit cards do you accept?

American Express  Discover          Visa              None    
Master Card       Master Charge     Diners Club       

Other Credit Cards accepted:


We will contact you for a date and time to take pictures. What are the best times for you?

What date will you be available for a photograph?

-- mm/dd/yy

What time will you be available for shooting pictures?

-- hh:mm:ss am/pm


Please write a short greeting and personal history for your customers. If possible write a letter in the form you would like it done on your page. For example: Country, state, and city where you were born, hobbies and past achievements. If you like to travel out of town or have interest in a certain type of trip let everyone know. 


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Copyright 2000 Edward A. Korgan Jr.,  All rights reserved.
Revised: October 16, 2010