Easy eHavasu.com Website Application:

Print and complete this form, gather the required materials, and mail everything with a check for $150.00 to:  Stephen Malm Consulting & Services, 24020 Mobile Street, West Hills, CA 91307*  (also a Blue Canyon Rd, Lake Havasu City part-time resident)

General Information (private)

  Name:

  Contact Phone Number:

  Contact Email Address:

  Email address to forward yourcompany@eHavasu.com mail to:

New Website Information (public)

  Requested subdomain name:

http://___________________________.eHavasu.com

  Business Name:

  Business Type:

  Address:

  Phone Number:

  Fax Number:

Include with this Form (you may also email this information to admin@ehavasu.com)

1.  Your Company Logo.  Printed or in electronic format.

2.  Up to 5 photographs you want on your website.  Printed or in electronic format.  If you would like the photographs returned, please specify.  eHavasu cannot be held responsible for photographs lost in the mail.

3.  Text which describes your business and what you do.  This may be from one to ten paragraphs.  Printed or in electronic format.

4.  Any basic additional information you would like to include on your one page website.

5.  A check payable to Stephen Malm Consulting & Services for $150.00