Customize A Logo

Ready for me to customize a logo for you?
Fill out this form, follow the instructions and
I'll get it to you right away!

Logo Customization Form

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Web Site URL

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Home Phone*
Home Phone*

Business Phone

Name of Logo You Want Customized

Text, as you would like it to appear*
Text, as you would like it to appear*

Do you have an image to include?*
Do you have an image to include?*

	Yes, I'll email it to you.
	No, just text on this one.

Would you like to customize the color scheme also? add $5

	Yes, please!
	No, thanks.

If Yes, Please tell me which colors to use. (A link to a site that has the color scheme you want is very helpful)

Please enter the word that you see below.

Payment options will be offered on the next page.