Order Form

CONGRATULATIONS - By filling out this form you are taking the first step to building your business presence online and taking advantage of the vast potential of the Web to send business your way!

Contact TMPDM for at 1-800-223-0074 for any additional information, or for assistance in filling out this form.

Submit this form to begin this great opportunity to utilize the web for potential sales.

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Get the New Template	Yes No
If you currently have a TMP-hosted website, you can transfer to the new template now
	Sub Total $100.00
Basic Package - $320.00	Yes No
Includes: Home Page - Your choice of color scheme and images Indoor Air Quality Page Contact Form - Consumer Feedback Form forwarded to you via e-mail / fax 2 Additional Page of text or Product Pages Link to existing Website & Corporate Website Unlimited text revisions during the year at no charge Internet consultations / support (account group) Monthly distributor site "click through reports" via e-mail / fax Toll Free 800 number Internet Client Services hotline Consultation on Web Marketing Solutions Annual Hosting and Maintenance of site Custom URL (example: www.abc.com)
	Sub Total $320.00

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Additional Options - (Not covered under Aprilaire Co-op Plan)
Please check the following custom feature(s) you would like to add to your Website.

Additional Text Page ($100 per Additional Page)	Yes No	$
OnlinePromotions Page/ Coupon Page ($100 for 4 coupons)	Yes No	$
		$

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1. Do you currently have a web address that you would like to use for this web site?

Yes - Please list it here
No - Select the web site address you would like:
2. Do you have a company logo you wish to include on your site?
Yes - Please send to webpagesupport@tmpdm.com
No - Use a Generic-style logo
3. Business Information:
Name:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Email:
Contact Name:
Business Hours:
4. Which Color Scheme/Image Gallery would you like?
Blue Yellow Green
5. Please provide specific details on additional pages.
6. Do you have specific copy on each additional page of your website?
7. Please list any products that you would like to appear on the web site.
8. If there are any other details that you would like to include, please do so below. Thank you!

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I authorize TMP Directional Marketing to create the web page selected to my specifications.
I agree to use TMP Directional Marketing as my Interactive Agency for one year.
I authorize payment for service.

Authorizing Name:
Date:

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Payment:

Check - Payable to:
TMP Directional Marketing
7800 West Brown Deer Road
Milwaukee, WI 53223

Charge Card (A TMP representative will contact you for your credit card information.)

After receipt of this agreement, a TMP Directional Marketing Interactive
Specialist will contact you to begin building your custom website.