RESPONSE CUSTOM BRANDED FACEBOOK COUPON APP ORDER FORM

Ready to Get Started? Just Fill in the blanks below and we will get to work for YOU!

Your Custom Coupon APP will include:

- Reveal Page with "LIKE-GATE"

-Social Sharring links for

-Google+

-LinkedIn

-Facebook SHARE

-Facebook SEND

Business Name *

Contact Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Cell Number

Email Address *

Business Website Address

Business Slogan or Text to be Included 🛈

We Currently Have a Facebook Page for Our Business *

If Above Answer Is YES, Name of Page

Desired Name For My Page

Please Upload a Picture or Logo Here

Have a Special Coupon You Would Like to Offer?
You can upload it HERE or we can create it for you.

Can't find the pictures or simply don't have them yet? Not a problem. Simply email them to Support@ResponseMarketingServices.com Please try to do so with in the next 48 hours.
Keep in mind we can always change or add pictures later. This is a free service with your
subscription. We aim to please.

Subscriptions

Yes, I need a Custom Facebook Business Page *

Custom Facebook Business Page Coupon APP Just $697 and $47 Per Month. Includes up to 12 Changes per year to Coupons and Page hosting and maintenance.

We value the confidence and trust you have put in us to create this siite for you and your business. Rest assured we will not be happy untill YOU are Happy with the end result. Thank you, we enjoy the opportunity to work with you.

~ The Staff at Response Marketing Services

Promo Code

Payment Information

Payment Type

Pay By Credit / Debit Card ( Fill in Information Below )

Pay By Check ( Find Address Listed Below)

If paying by check. Please send payment to:
Response Marketing Services LLC
4072 Chicago Dr Suite 25
Grandville Mi 49418

Please Read and Agree to the Following:

I understand the fee I am being charged today includes the site creation but also the first month of site
hosting and maintenance. I also understand I am allowed up to 12 changes or updates to the site images,
pictures of coupons per year with my subscription. I also understand that I will have full access to the
members training site. Additional changes above those provided are billed at $30 per hour with 1 hour

minimum billing.

*

YES

I also understand that this is a monthly subscription and that I will be invoiced or my card provided will be charged $47 per month for hosting and maintenance or I can pay $400 on a yearly basis untill I cancel this service. If payment is not recieved within 60 days of page creation or anniversary date my service will be turned off. I understand should I ever choose to cancel this subscription that all tabs created, images and portions of this service provided shall be permenently lost. Cancelation information. Simply send an email to Support@ResponseMarketingService.com with the subject CANCEL, along with your store information, or a letter of cancelation to the address listed above. *

YES, Bill me Annually $400 after site creation

I'd rather Pay $47 Every Month after 1st month

Name on Card

Card Number

Expiration Date (mm/yy)

CVV Code 🛈

Billing Zip Code

Email Address for Reciept

On behalf of the above named client, I have the authority to accept this agreement and hereby authorize Response Marketing Services, its agents, and/or assignees to proceed with the work according to the description and cost herein and I agree with the Terms and Conditions. I understand that this agreement is not binding until accepted by Response Marketing Services LLC. and I authorize the credit/debit card information herein to be billed for the fees as outlined herein.

Name of Authorized Person

Want to add a custom video or Coupon to your page? Not a problem. Simply put the link to the video or the contents of the coupon in the Comments box below. You can also attatch a copy of a coupon to the image capture section above.

	Comments or Special Requests
Thank you	Comments or Special Requests