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Customer Details
Name: * (required)
Company Name:
E-mail Address:  * (required)
Phone:  * (required)
Background & Objectives:
What does your business do?
Services Required: Design new site; number of pages
Re-design current site
Domain Registration & Hosting:
Do you need a domain name registered? Yes No
Current Domain Name (URL): ex
Do you want hosting set up for you? Yes No
Web Site Look & Feel:
What other sites do you like that are similar to the type of design you want?
What do you like about them?
What do you NOT want on your site?
What graphics, photos and other art do you have?
What graphics, photos and other art do you need designed?
Web Site Content & Scope:
Will you write the text or will we write it? I Write It You Write It
Other information:
Additional Information:
What is your design budget? :
Do you have a deadline when the site must be completed? If yes, when:
Questions or other information we may need:
Please enter the string shown in the image in the form.
The possible characters are letters from A to Z in capitalized form and the numbers from 0 to 9.
All character is in Big / Capital Letter

Thank You








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