Custom Screen Saver Creation Service Fee Order Form 

Please print out this mail order form, fill it out,
and email it to customscreensavers@glipsentertainmentinc.com

GLIPS Entertainment, Inc
102 West Vance Street
FuQuay-Varina, NC 27526
USA

For Checks, please allow 7-14 days for bank clearance.


SHIPPING INFO:
Your Name:
Your Company:
Your Street Address:
Your City:
Your State:
Your Phone: (xxx).xxx.xxx ext.


DELIVERY DATE REQUEST:  mm/dd/yyyy
(depends on availability)


NAME REQUEST FOR YOUR CUSTOM SCREEN SAVER:


CUSTOM SCREEN SAVER CONTENT INFO:
Your Website URL: (www.yourwebsitenamehere.com)


Your Logo location URL:


Your Image file names and locations-(35 Maximum)
  -WebPage or direct file links accepted-


Your Music file names links-(20 Song Maximum)


YOUR PREFERRED PRODUCT DELIVERY METHOD:  (Please Select with an "X")
CDRom Shipment                  -- [  ]
Email Delivery                  -- [  ]
Website Download Delivery Link  -- [  ]


Copyright (c) 1999-2003 GLIPS Entertainment, Inc.  All Rights Reserved.