Please complete this form and return it with a cheque to:
Artists Website, Positive Change Creations Ltd, 32 Denton Road, Richmond, TW1 2HQ
Your Details
Your Name:		___________________________________
Email Address:		___________________________________
Day time telephone number:		___________________________________
Address:		___________________________________
		___________________________________
		___________________________________
Preferred Username:		___________________________________
Your Website
Have you got an existing domain name (web address) that you want to use?   YES / NO
If you have an existing domain you want to use, you will need to fill out a domain transferral form and fax or send it to your existing service provider. You can print this form from our website at http://www.artsCurator.co.uk/pages/forms/transferDomain.html
What domain name would you like your website to have? (You can use our online search tool to find an available address if you do not have one already.)
		___________________________________
Do you want an email address set up with your website?   YES / NO
Payment
Please enclose a cheque for the correct amount payable to Positive Change Creations Ltd. Please complete and sign the Standing Order Mandate and send it to your bank. You can print this out from our website at http://www.artsCurator.co.uk/pages/forms/standingorderform.html
Terms and Conditions
Please read the terms and conditions for this service. By signing this form you are verifying that you understand and are agreeing to our terms and conditions. You can read these on our website at http://www.artsCurator.co.uk/pages/legal/terms.html
Signature:		____________________     Date:______________________