Name:

Company: 

Address: 

City:  State:   Zip:

Phone:  -

Email: 

Do you currently have a Web Site?  Yes    No

If you answered YES, what is the URL (address)?

Please describe below what you would like changed on your site?

If you answered No...  Please check the type of Web Site you would like:

    One-Page Informational Site

    Corporate Site:  Specify number of pages: 

    Customer Support Site:  Specify number of pages: 

    Personal Site:  Specify number of pages: 

    On-Line Store:  Specify number of products:  (1-10,000)

    Informational (On-Line Brochure):  Specify number of pages:  

    Combination:  Specify number of pages: 

    FLASH (Animation/Movie):  Specify number of pages: 

    Not Sure

Do you want to sell things on your site?  Yes     No

    If YES, do you plan to accept credit cards on-line?   Yes     No

Do you have a merchant account?   Yes     No

Please select Web Site Content pages you would like below:

Other Pages:  Please List:  

Additional Considerations:

Do you need to register a Domain Name?  Yes     No

Do you want E-Mails at your Domain Name?  Yes     No  

    (example:  yourname@yourdomain.com)

Do you have web ready graphics?  Yes     No

Do you need graphics created (i.e. logo & other graphics)  Yes     No

Will your site need to be updated/changed periodically?  Yes     No

Any other issues you would like considered in this quote:

Did someone refer you to our site?  If so please list their name below as we reward customers for referrals: 

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