Welcome to the ION Belgard Sponsor Website Program!

Belgard Profile: Contractor Dealer

Personal Information

Company Name: *
Contact First Name: *
Contact Last Name: *
Address: *
City: *
State: *	[ Select ] AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code: *
Phone: *
Cell Phone:
Fax:
E-mail: *
Other E-mail:

Spoke to Salesman:	- No - Yes [ If Yes, please select ] Jenny Butero Jerry Earwood Wendy Ginn Glenn Gosnell Jay Henningson Stacey Kronshage Peter Saxon Tracey West
Belgard Manufacturer:	[ Select ] 4D OLDCASTLE MI ADAMS PRODUCTS COMPANY NC AKRON BRICK & BLOCK OH AMCOR UTAH BLOCK UT ANCHOR BLOCK FL ANCHOR CONCRETE PRODUCTS NJ BALCON MD BEND INDUSTRIES WI BETCO SUPREME VA BIG RIVER INDUSTRIES, INC. GA BIG ROCK BUILDING PRODUCTS TN BONSAL NC BOSSE CONCRETE PRODUCTS GA CONCRETE DESIGNS, INC. AZ CUSTOM-CRETE, INC. TX DIXIE STONE - MI DOMINE BUILDERS SUPPLY NY EAGLE CORDELL TX FOSTER SOUTHEASTERN MA GORIA NC JEWELL TX MILLER MATERIALS MO NORTHFIELD BLOCK IL OLDCASTLE CEMENT MIXES WA OLDCASTLE EASTON PA OLDCASTLE SHEFFIELD OH OLDCASTLE STOCKTON PAVER SYSTEMS FL PERMACON CAN SCHUSTER'S IN SIERRA BULDING PRODUCTS CA SUPERLITE BLOCK AZ TRENWYTH AZ TRENWYTH INDUSTRIES PA YOUNG BLOCK AZ
Belgard Dealer/Supplier:
Belgard Sales Rep:

Site Building Instructions

(a) Do you have an existing website? - No - Yes (if Yes enter it below) Website: http://

(b) Do you have an existing Domain Name? - No - Yes (if Yes fill the fields below) Domain Name: Domain Registrar: (c) If not, list three potential domain names: 1. 2. 3.

(d) Do you have a company logo already? No Yes

(e) Do you have photos of your work? No Yes

(f) List three design color choices in order of preference: 1. 2. 3.

(g) Select a design theme that best matches your company: [ Select ] Traditional Craftsman Corporate/Commercial Natural/Organic Contemporary Artistic Elegance

(h) Please describe your company, services and products:

(i) Select all categories that apply to your business: - Residential - Commercial - Paving - Retaining Walls - Hardscaping - Landscaping - Water Features - Irrigation     OR Others:

(j) List 5 or 10 of your top selling products:

Payment

Choose a Payment Method: Credit Card (monthly) Electronic Check (monthly) Company Check (12 months advance) Notice of Conditions Clients paying via Credit Card pay first month + last month in advance. Check payments must be paid for 12 months service in advance.

Billing Address Same Address as above Name: Address: City: State: Zip:

Service Terms

Our Service Terms Thank you for your interest in our ION Web Site Program. Below is a list of our Service Terms and Conditions that must be agreed to, by you, in order to be approved. 1. You understand that you must be authorized by your local Belgard Manufacturer, before signing up for this ION Web Site Program. 2. You agree not to add or promote any direct competing Hardscape Manufacturer's products on your web site unless authorized by your local Belgard Manufacturer. You may add a URL link to other Hardscape Manufacturer's web sites, but not actual content. 3. You agree not to cancel your web site and payment within the first 12 months of your web site "Live" date. You also agree that there are no payment refunds or charge-backs after you have been charged, regardless of the reason whatsoever. 4. You authorize Clear Imaging, Inc. to charge your credit card, checking account or debit card for first and last month’s payment (2 months) upon the commencement of your web site project. Generally, this first charge occurs on the 15th day of the current month if the sign up date is between the 15th to the 22nd of the current month. If you sign up after the 22nd of the month, your first and last month’s payment will roll over to the next month on the 15th. 5. You understand that this Web Site Program is based on ongoing payments over a 5-year period, at which point you will then own the web site outright, including all copyrighted materials and contents. You will have the option to discontinue services at that time, or choose to continue our services on a month-to-month basis. However, if we provide you with a complete new web site redesign and rebuild for free, at any stage within this initial 5-year period, the service terms will restart for an additional 5-year period. 6. You agree that if you do cancel your web site and payment within 5 years of your web site "Live" date, you will not be able to take ownership of the web site design or it's copyrighted contents. The only option would be for you to pay the remaining balance of the 5 years service fee, before we would release the web site to you. 7. You understand that if you do cancel your web site and payment within 5 years of your web site "Live" date, you will not be able to take ownership of the web site domain name, unless you had registered it yourself via a third party registrar, if not, you would have to pay a $250 domain name transfer fee before we release the domain name to you. 8. You understand that all minor web site changes and updates are included as part of your monthly fee which includes, web site hosting, e-mail accounts, storage and bandwidth. However, major web site changes and updates such as a complete web site re-designs, major navigational changes, database driven applications or e-commerce integration will require additional charges based on the complexity and time needed to accomplish them, which will be determined by Clear Imaging in a Web Scope Outline upon request. 9. You understand that your payments will be used primarily to pay for your web site over a 5 year period, which includes minor site updates and "Organic" search engine optimization on major search engines, such as google and yahoo, plus directory listings on other web site portals such as PaverSearch.com and LandscapePlanet.com. 10. You agree that your monthly or yearly service fee will be charged via Clear Imaging, Inc., by either Credit Card, Electronic Check or Regular Check depending on your preferred method of payment and chosen service plan. 11. You hereby agree to abide by all the above Service Terms and Conditions before signing up for any of our web site plans. By continuing forward, you are agreeing to all of our Service Terms and Conditions as written here, which may be used as proof in the event of any disputes. Clear Imaging reserves the right to change or update these Service Terms and Conditions at any time without prior notice. Therefore, we recommend you print a copy of these existing Service Terms and Conditions by clicking the link, provided to the right side of this box, which will “grandfather” you in, and override any future changes made to these Service Terms and Conditions. Clear Imaging, Inc. 711 S. Carson St. Carson City NV 89701 Phone: 800-380-6942 - I Agree Service Terms and Conditions Print Service Terms and Conditions

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By clicking on the "Continue" button you hereby agree to abide by our Service Terms and Conditions before signing up for any of our Program service plans.