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Exclusive Design Order Form

Use this secure form to order your fully-installed, customized Electrology Practice website with artwork and design elements exclusive to your practice (within sites created by Hammer Data Systems, LLC). Note: Transgender images may not be exclusive due to the limited number of high-quality transgender images available from which to choose.

Once you place your order, we will contact you to discuss your requirements. We will then select an artwork package and prepare a sample page layout for your approval. Once you approve the samples, we will license the artwork for you and populate your site with your practice information and the AEA-provided treatment area and FAQ pages. You will be able to review the site and give final approval before it is made publicly available.

You will receive two charges on your credit card. The first charge is from us (Hammer Data Systems, LLC). It covers the base package charge of $1000.00, any optional extras you request, and the image licensing fees which we pay to iStockPhoto or a similar stock art site on your behalf. This is a one-time fee. We will never charge you another dime unless you contact us and ask us to do something for you. We recommend you allow us a stock artwork budget of at least $100.00. You will receive the full-quality originals of any artwork licensed on your behalf.

The second charge will be from the hosting company. It will cover 1 or 3 years of hosting, depending on which you choose. This will renew at the end of each term. The domain name and hosting account will be in your name and you will have all of your passwords. You are not bound to Hammer Data Systems in any way.

If you need help with this form or want to place your order by telephone, please feel free to call us at 330-527-4018 or to email us.

Your Preferences

Tell us what you like! There are no wrong answers. We need to choose from thousands of available stock images and design elements. The choices you make below will provide us with some guidance on the image you want to project to potential clients. In each case, choose the image that best represents your focus. You will always get a range of images, but your choices will tell us where to center that range.

Choose your colors!

Which picture best reflects how you want the people shown on your site to look?

Which picture best reflects how you want the people shown on your site to feel?

Which picture best reflects the personality you want to convey?

Which picture best reflects your office/treatment environment?

Which picture best reflects the amount of sexy that is right for your website?

To which age group do you most want to appeal?

To which ethnicities do you most need to appeal, based on the demographics in your area? Select all that apply.

To which ethnicities do you least need to appeal, based on the demographics in your area? Select all that apply.

We will need to purchase licenses for stock artwork on your behalf to use on your site. The images vary in price, but each image is likely to average at least $7.00. For best results, we need 10 - 12 images, so we recommend a minimum budget of $100.00. We may not use your entire budget, but we will never exceed it. We will always attempt to choose the least expensive images that fit your design, but if you want lots of pictures, you may want to increase the allowed budget.

If Yes, we may use non-exclusive images that are part of an AEA image package to fill out your site.

Site Information
The domain name is your website address. It cannot contain any spaces or special characters like slashes. Example: MyElectrolysisPractice.com

Your Practice Information
If Yes, we will use this information to set up your locations, modalities, etc. Otherwise, we will contact you for this information.

Contact Us Information

About Us Information

Rates/Policies Information

Links Information
Optional Extras

Please select any of the optional extra items or services below that you would like to have added to your site. We will contact you for any additional information, such as testimonials, services information, a description of your desired colors/layout, your business card, etc. that may be required to complete your request.

Hosting Options

These options affect how we set up your hosting package. All fees from these options are paid to the hosting company, not to Hammer Data Systems.

This locks in the introductory monthly rate for three years instead of only one year.
This keeps your contact information private and reduces spam.
Billing/Contact Information

Please enter information as it appears on your credit card billing statement.

Credit Card Information

Comments and Additional Information
Terms and Agreements

I understand that by submitting this order form, I agree to the following:

* I agree to the above terms

Note: Your credit card will not be charged by submitting this order. We will confirm your eligibility for your selected theme and contact you with regard to any optional extras you have selected before charging your credit card.

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These website packages have been authorized by the American Electrology Association and are available exclusively to AEA Members. Not a member? Join the American Electrology Association today!