Thank you for reserving services. We look forward to providing you quality, professional services at tremendous value. By reserving services today, you lock in the current pricing rates offered on the Web Site at the time your reservation is made provided a 50% (fifty percent) deposit fee for the service has been received within fourteen (14) days of submitting this reservation. Payment can be made by check or Paypal.*
[*Paypal allows you to pay online with a credit card. If you select this method we will email you complete instructions for your particular purchase.]

If paying by check,
make checks payable to DELTA NEW MEDIA
and mail to: Delta New Media
4924 Balboa Blvd., #427
Encino, CA 91316

So that we can best process your reservation, please fill the form out as completely as possible. A representative will contact you within 24 hours of receiving your submission Monday through Friday. [Please be aware that Internet viability issues beyond our control can effect how quickly your submission is received.]

Thanks very much for your interest. To avoid bogus submissions, please fill the form out then PRINT it and mail a hard copy to us. Thank you very much.
                                 Services Reservation Form

First Name:
Last Name:
E-Mail:
Repeat E-Mail:
Company:
Your Title:	Your relation to subject business I am the Owner I am the Manager I am an Other Employee
Authorization Verification:	I am authorized to authorize the requested services Yes No
Who is responsible for payment?:
	Service(s) you want to reserve. Select all that apply. Value Pack [VP] Postcard Pack Domain Management Hyperlinking Web Site Marketing Shopping Cart Web Site Management Custom Services Logos & Branding Copy Writing E-Mail Hosting Special Features Other Features
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone #1:
Phone #2:
Name of business service is for:
Type of Business:
Payment Method:	Select Your Preferred Payment Method Paypal Check Either Check or Paypal
Business Address Line 1:
Business Address Line 2:
Business City:
Business Zip:
Project Description / Detailed Message: