Contact Information

Your Name, or person to contact:

Company Name:

City: State:  Zip Code:

Email:

Primary Phone:  

Cell Phone:

Contact Preference: Email  Phone Regular Mail

Services Requested

Please check all that apply:

New website and hosting.

Hosting only.

Edit and/or update existing website. (see below)

Domain Name Registration or Transfer

Logo design.

Photo editing

Other: (please explain)

Type of Website:

Choose one. Will build your own website using on-line builder included with hosting To describe and show products and services To sell products and services and accept payments on-line

How often will you need updates made: Choose One Never Monthly Annually Occationally

Approximately how many web pages will be needed?: Choose One 1 - 10 10 - 20 20 - 50 50 - 75 75 - 100 Over 100 Over 200

For Existing Websites

Your current domain name URL:

Your hosting provider:

Website Content

Do you have, or can you provide the text content you need published? choose one Yes, have all text content No, do not know what should be on website

For all web optimized graphics that will be published to the entire website:

choose one Will need all web graphics created Will need my gaphics and photos converted to web-ready Have all necessary graphics and photos ready for website

Would you like a Website Planning Worksheet mailed to you?NoYes

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