Online Brochure Order Form

Customer Information (Print or Type):

Name:

_____________________________________________

Company:

_____________________________________________

Address:

_____________________________________________

 

_____________________________________________

Phone:

_____________________________________________

E-mail:

   _____________________________________________

Payment Information:

1) Number of brochure pages

___ X $60 set up and design

=

$__________

2) Annual hosting Fee for
    up to five (5) pages

$60 ($5 per month)

=

$__________
 

Total Amount Due

=

$__________
     

NOTE: After we post your Online Brochure and make your requested--minor--adjustments to your pages, all additional modifications, such as seasonal changes, new rates, photos, design changes, etc. will be billed at $65 an hour (1/2 hour minimum).

Please make your check payable to Digital Renaissance, and mail your payment, order form, signed copyright release form, completed brochure template(s), photos, text, and graphics to:

Digital Renaissance Multimedia
ATTN: Explorer1.com
508 Buena Vista Avenue
Santa Cruz, CA 95062

NOTE: If you would like your materials returned to you, please send a Self Addressed Stamped Envelope (SASE) that is adequate to safely return your materials in.

Thank you for your participation!

(Rev. 4/9/01)

PERMISSION TO USE COPYRIGHTED MATERIAL

RELEASE: This confirms that any photos, graphics, text, etc. furnished by me, (print your name) _________________________________, are either my own or their use has been authorized by the owner, without any financial obligation upon me, you, or any third party.

USE: I understand and agree to the following uses of my material:

To include the material in my company’s Online Brochure(s), Online advertisment(s), WebCoupon(s), and/or Custom Web Site that will be produced and displayed by EXPLORER1.COM (a service provided by DIGITAL RENAISSANCE MULTIMEDIA).

CLAIMS: This agreement expressly releases DIGITAL RENAISSANCE, EXPLORER1.COM, their members, officers or employees, their successors, personal representatives, and any other organization transmitting, publishing or exhibiting said material, from any claims, known or unknown, arising out of or in any way connected with the above uses.

LIABILITY: I agree to be fully responsible for my own participation and for the material that I have furnished, to hold DIGITAL RENAISSANCE, and EXPLORER1.COM harmless from any liability, loss or expense arising therefrom, to defend and protect DIGITAL RENAISSANCE, and EXPLORER1 from and against any and all actions or suits at law or equity of any nature.

COPYRIGHT HOLDER

Signed:______________________________________________Date:_______________

Print Name:______________________________________________________________

Company Name: _________________________________________________________

Address:________________________________________________________________

City:____________________________________________________________________

State/Province:_______________________Zipcode:__________Country:_____________

(Rev. 3/6/99)