ROI Web Tracking Form Sign-Up

To signup for our ROI tracking form service, just fill out the form below and click on the submit button.

Our ROI Tracking Form has two service levels to choose from.

The first is the Hosted Web Inquiry Form which includes fields for basic contact info, incuding a text box for the user to ask any questions of you as well as the ability for the users to attach an a file with their question/RFQ. This costs $199.95 the first year and renews at 149.95 per year thereafter.

The next option is our Custom Hosted Web Inquiry which includes the ability for your to add up to 50 custom data fields to your form. These can be used to make very spicific and targeted RFQ/Inquiry forms that will get you all the infomation you need to respond to your prospects quickly and specifically. This service costs $299.95 the first year and renews at $249.95 per year thereafter.

Fill out the form below and we will contact you before any thing is charged to your credit card.

If you are not a CIIC client you will need to supply FTP access information for your website. You can still fill out this form and we will contact you if we need any additional info.

Contact Information:

Your name:

Your title:

Company:

Your e-mail address:

Daytime phone:

Fax:

Web Address To Be Tracked :

FTP Server Address :

FTP Username :

FTP Password :

Service Option :
 

Payment Information:

*Select Payment Type:
Site will not be live until payment arrives and clears if paying by check.

Credit Card Number:

Credit Card Expiration Date:

Exact Cardholder Name:

Credit Card Billing Address:

Billing Address Line 2:

*Billing City:

*Billing State/Province:

*Billing Zip/Postal Code:

*Billing Country: