Vivax Corporation Home Page
 Use Our On-line Forms:
     Customer Service 
   Technical Support 
   Information Request 
   Order a Web Package 
   Have a Vivax Representative Call 
   Comments or Suggestions 
   Message for the Web Master 
   Job Opportunities 
Contact Us 

Use this form to order your Web Development Services or, if you prefer, e-mail Sales Support.  This form may be used for ordering your QuickStart Package or to provide us with basic information about your business so we can be prepared before we contact you.

 Client Company Information

Company name:
Company address:
domain name:
This is a registered Internet Address
(Please list your choices in order of preference.  We will check and let you know about availibility.)
Your e-mail 
  (In case we cannot reach you by phone.)

 Contact Information

Contact name:
Your phone number:     Please call me
Your Fax number:   (Optional, listed on your site)
Where are you located:  
Best time to call:  

 Web Site Requirement

Objective of Site:   Enhance the image of the firm
Reach out to new clients
Improve relationship with existing clients
Improve productivity
Increase profitability
Sell products (E-Commerce)
Provide support services
Other (See Comments Below)

Other Information:   You have a business card/Letterhead
You have a Logo
You have additional graphics/photos
You require Vivax produced graphics
You require Video for your site
You require Audio for your site
Special requirement (See Comments Below)

Service or Product


Your Current
Client Profile:


Web Package:   QuickStart Web Package
Custom Designed Web Site
Copyright ©2000-2004, Vivax Corporation, ALL RIGHTS RESERVED
Massachusetts, USA
Customer Service