Changes Request

	Changes Request
	Please complete the following form to receive a time/cost quote on your changes request. *Items marked with indicate a required field.** If you have any questions, please contact Customer Support at http://support.myquickresponse.com/

Upon receipt of your changes request, you will be contacted by a Changes Consultant. Please be sure you have entered the best phone number and time to reach you.

Disclaimer:

To receive a valid order number and minimize the possibility of delay please submit your changes through this website and attain a valid order number. Requests that are not associated with a valid order number may be delayed up to or beyond 15 business days from date of receipt.

First Name: ^*
Last Name: ^*
Address: ^*
City: ^*
State / Province: ^*
Postal Code: ^*
Country: ^*
E-Mail: ^*
Phone: ^{* EX: 8012270004}

What is the best time to contact you by phone (MST): ^*

	Customer ID / Certificate Number:
	URL: ^*

What changes are needed
(Check all that apply)

Contact Information Update / Change
Authorizenet Connection
E-mail Alias / Address Update / Change
Create New / Edit Payment Method
ECI-PAY Connection
ECI-PAY Connection
Changes Error
Orders Not Working
Display Problems
Contact Changes
Changing URL Address
Title Change
Meta Tags
Modify Text
Edit Links
Modify Graphics
Edit Product information
Modify Form: Change E-mail Address
Modify Form: Add / Edit Fields
Logo
Navigation
Modifying Design
Adjustments to / Create New Tax Rules
Adjustments to / Create New Shipping Rules
Adjustments to / Create New Discount Rules
Adjustments to / Create New Target Market Pages
File Upload
Addition of Links4Trade Code
Add Links
Webrings
Adding Bannercode
Flash Programming
Sound Editing
Graphical Animation
Video Media
Custom Java Script Programming
Other (Please explain)

Other:

	Please be very specific!
	Please answer the questions as best you can. Please be very specific in regards to what pages and/or products your changes will affect.

Detailed Description of requested changes: ^*

	Pages:
	Please indicate what pages are affected by this change. If all pages are affected, type "All" in the space provided below. If only specific pages are affected, indicate exactly what pages (Contact Us, Products, About Us, etc.). If your change pertains to a product only (does not change any pages), type "None" in the box below.

What pages are affected? ^*

	Products:
	Please indicate what products are affected by this change. If all products are affected, type "All" in the space provided below. If only specific products are affected, indicate exactly what products by listing item numbers (ex: #'s 100, 102, 104, 016, 108, etc.). If your change pertains to page(s) only (does not affect any products), type "None" in the box below.

What products are affected? ^*

	We will contact you!
	Upon receipt of your changes request, you will be contacted by a Changes Consultant. Please be sure you have entered the best phone number and time to reach you.