Website Insurance Website & Data Insurance (webdi)


Website Rearrangement/ Repair Insurance & Technical Support for one year of Unlimited Web Maintenance!

Please provide your contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
Website

Please identify and describe yourself:

Date of Birth
Sex Male Female
Height
ID Number
Hair Color
Eye Color

Choose one of the following Website/ Data Rearrangement Insurance options:


(
e.g. 1 :- Payment for 100MB: 1/4 of 3/4 payment, 4 times within the year )

( e.g. 2 :- Payment for 50MB: 1/3 of 2/3 payment, 3 times within the year )

Would you like us to Repair your Website?

Yes No

What do you think of this first Webdata Insurance?


How would you rate your opinion of this Webdata Insurance?

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Enter the date of today:


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