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Please complete, as best as possible, all of the information on the form below in order for us to understand you custom Web site development needs. The more information you complete, the more accurate the quote.

Contact information

Contact Name [First & Last ]:

Business Name:

Street Address Line 1:

Street Address Line 2:



Zip Code:

Business Phone:

Cell or Other Phone:

Fax Number:

E-mail Address:

May we contact you by phone if we have questions regarding your request?:
Yes   No

When is the best time to contact you?:

How would you like to receive your quote?:
By Fax
By Phone
By E-mail
By US Mail

Tell us about your business

Type of Business:

Please describe your business with details as much as possible:

What is your budget for this project?

Requirements For Site

Do you have a Domain Name registered? (e.g.
Yes   No

If you do not have a Domain Name registered would you like us to register one for you?
Yes   No

Do you require Web hosting services for your web site?
Yes   No

Do you require Webmaster maintenance services for your site after it is created?

Yes   No

If you answered "Yes", please enter your Domain Name below:

How many pages will your Web site consist of?:

Are you interested in having graphics images or photographs on your site if yes how many?:

Would you like a form(s) on your site? (e.g. contact / feedback form similar to the form you are using to request a quote):
Yes   No

If you answered yes, how many forms would you like:

Would you like e-mail accounts for your Web site?
Yes   No

If you would like e-mail accounts, how many accounts do you need?

Would you like to accept credit cards on your site?: (Note: eCommerce Merchant site prices begin at approximately $1000.00 and monthly hosting costs are much higher than non-Merchant sites)
Yes   No

Do you currently accept credit cards in your business?:
Yes   No

Do you currently have a Merchant Account from a bank?:
Yes   No

How would you be supplying the text content for your site?:
Electronic Format (i.e word processing files)
Hardcopies (i.e. you would require us to type all the text

How would you be supplying the graphic content (i.e. your logo, pictures, etc.) for your site?:
Digital Format
You would require us to scan your images or photographs

After your Web site has been completed, would you like us to submit your Web site information
Yes   No

Additional information or examples of Web sites( URL's)  you like:

Please tell us how you found our Web site:

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