Your personal name:
  
Trading as name:
  
Address:
  
Town:
  
City:
  
Post Code:
  
Telephone:
  
Public E-mail (the one every one can contact you with):
  
Services provided, you can add more later:
 
A short message about your services, to get your page going:
  
Paying by card, enter type, Visa, Master, etc:

Issue Number SWITCH ONLY:

Card Number:
  
Card Security Code, last three digits in signature strip: 

Starts:
  (mm/yy)
and Expires:
  
Amount to be debited £

One year basic £15 - Three year basic £30
One year single image £20 - Three year single image £40
One year multi image £25 - Three year multi image £50  
Price includes maintenance and updating as you require.

We will debit your card once the basic site has been uploaded.
This is for the one or three years. We will email you when renewal is due.

Take a print out of this page for your own records.

Email this form to
graham@weddings-in-wales.co.uk

You can pay by card over the phone 01792 229191
Tuesdays to Fridays 9.30am till 1.00pm

Or post with your cheque payable to Galaxy Studios
The Weddings in Wales Website
Galaxy Studios
3 Bryn Terrace
Gorseinon
Swansea
SA4 4DE