| First Name:
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| Middle (optional)
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| Last Name
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| Company Name
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| Email Address:
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| Phone (optional)
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| What services are
you interested in? (Check all that apply) : |
New web
site :
Web site upgrade :
Web site maintenance ( continued service
):
Other (please include a descripton in the
other information box at the bottom of this form):
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| When are you
looking to begin? |
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| How soon will you
need the site completed? |
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| What is your
total web design budget? |
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| Approximately how
many pages will your website require? |
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| Will this be an
e-commerce site? |
Yes
No.
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| Will website
process payments? |
Yes
No.
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| Do you require
website hosting? |
Yes
No.
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| Provide any sites
that has the feel or functionality your looking for. ( seperate with
comma's please ) |
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| Provide any
details, additional information, or anything that will aid in us
getting your an accurate quote:
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