Contact information

Contact Name [First & Last ]:

Business Name:

Street Address Line 1:

Street Address Line 2:

City:

State
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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

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Tell us about your business

Type of Business:
Select Type Small Business Large Business Non-profit

Please describe your business with details as much as possible:

What is your budget for this project?

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Requirements For Site

Do you have a Domain Name registered? (e.g. www.name.com)
Yes   No

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

How many pages will your Web site consist of?:

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
Other:

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: