Please print out and fill in the following form
and enclose it with your check.

When you have completed this form, please send it with your check to:
Brilliant Wedding Pages
Brilliance Web Design, Inc.
P.O. Box 667
Hales Corners, WI 53130

Bride Full Name:

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Groom Full Name:

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URL (Wedding Website Address): http://www.bwedd.com/

Login:

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Main Contact: (Circle One)      Bride          Groom

E-mail of Main Contact:

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Phone Number of Main Contact:

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Please Circle the add-ons that you would like on your site and write the total yearly price in the space provided:

	Welcome Message	Free
	Online RSVPs	$12/yr.
	Photo Albums (Unlimited)	$15/yr.
	Wedding Countdown Timer	$5/yr.
	Guestbook	$6/yr.
	Wedding Ceremony & Reception Info	$7/yr.
	2 Pictures	$5/yr.
	Personalized Wedding Quiz	$15/yr.
	Our Story	$8/yr.
	Wedding Party & Bios	$7/yr.
	Inspirational Wedding Quotes	$5/yr.
	Parties and Showers	$6/yr.
	Places to Stay	$6/yr.
	Audio Message to Guests	$10/yr.
	Future Plans	$8/yr.
	Wedding Gifts & Registries	$10/yr.
	Things to Do in the Area	$6/yr.
	Contact Us	$5/yr.
	TOTAL	$_____________
Please make your check out to Brilliance Web Design, Inc. for the amount in LINE 4

Thank you for taking the time to fill out this form! Please allow 2-3 weeks for your site to be ready. We will notify you via e-mail when you may begin entering information for your site. We appreciate your business and hope that you will enjoy your wedding website. If you have any questions, concerns, suggestions or comments, please contact us! We would love to get your feedback and we are always willing to help in any way we can!

Sincerely,
The Bwedd Team