Please complete this order form to activate your account.:

	General Account Information Please be as accurate as possible.
e-mail
First Name
Surname
cell
Telephone
Facsimile
Province	Please choose.. Eastern Cape Free State Gauteng Kwazulu/Natal Mpumalanga North West Northern Cape Nothern Province Western Cape
	Profile Information Keep your profile information updated for future competitions.
Please choose a EasyWeb account	By choosing this option you agree to join us for 24 months. By choosing this option you pay one year cash and get 1 month free. Minimum 2 years. R1380 once of fee By choosing this option you pay once for the design.
Please choose a template	Endless Corners Soft Shapes Classy Blue Bubble Blue Silk Bold Curves Metal Shade 3d Orange Rounded Shapes Simplicity
Please supply us with two colours	formats: RGB / #000000 / CMYK If you don't have the colours now please skip this question.
Do you want your own domain name?	www.webdragon.co.za/yourname www.webmenu.co.za/yourname www.yourname.co.za If you clicked this option please give us three posible names. Domain registration at R250
Please feel free to add any comments.
	Please read the Terms & Conditions
	I have read and accept the terms of use.