LocallyHere Registration Form

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Please fill in this form and click the "submit" button to send us details of the website you require.We will let you know when we have received it and whether we need any more details. At the same time as submitting this form please send by e-mail (to images@locallyhere.com) an image of your logo plus several images of your business, products etc. for your website.

After you've received our reply you can go ahead and order.

Your name Your phone
Your name Your phone
Your email
Declaration: I declare that the information I provide in this form is accurate and that the business for which I am submitting information is either mine or that I am fully authorized to act on behalf of it.	Full Name: Date:
Your postal address
Postcode
Business name and type (please be brief - you can enter more details later)	Name: Type:
Business Address (please enter it as you would like to see it appear on your website)
Business contact details	Phone: Fax: email:
What does your business do?
How long have you been operating?
What are your main products and/or services?
Discount or Special Offer We recommend that you put one or more offers on your website for people who visit you through the website, for example by bringing a printout of one of your pages. Enter "no offer" if you don't wish to do this.)
Please give details of the key products and/or services you wish to feature on the website (if possible please provide pictures (by email) to support each product or service) Send images to images@locallyhere.com	Product 1: Product 2: Product 3:
Other information. In your 4 page LocallyHere website you can put extra details that doesn't fit elsewhere. For example, if you run a cafe you could put a menu here, or as an artist or p[hotographer you might include a portfolio of your work. NOTE: For an image gallery please e-mail between 5 and 18 high quality images. Please send menus either as images or as pdf documents. Send images to images@locallyhere.com Please use the text box on the right for any further text you would like to include.

If you have any questions about this form please email help@locallyhere.com

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