Complete this form for a FREE QUOTE on web site design.
Press submit and it will be emailed to me automatically.
* = Required Fields
*
This request is for a quote for:
A New Site
Remodel an Existing Site
*
Your Email Address:
*
Enter Your name:
Business Name (if applicable):
Street Address:
City:
*
State:
Zip Code:
Telephone: (
)
-
The above address is my:
Home:
Business:
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Select what type of web site you are interested in having designed
Personal
Business
Non Profit Organization
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Do you already have a URL or registered Domain name? Yes
No
Do you want to register a domain name? Yes
No
What is your URL? (freeserver or domain)
http://
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Will the site have a shopping cart?
Yes
No
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Will the site be processing credit card transactions or secure information?
Yes
No
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Will any areas of the site be password protected?
Yes
No
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Will your site require any additional graphics to be created?
Yes
No
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What will be the main topic or focus of your site?
*Please add any comments or special instructions about your site below:
