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Name:
Company:
Address:
City:
State:
Zip:
E-mail:

 

Which web design service are you interested in?

Personal Web Page

Business Site (Informational)

Business Site (E-commerce)

Domain Transfer

 

Do you have a specific theme or colors in mind for your website? If so, please describe:

 

Approximately how many pictures and/or graphics do you need scanned for your website?:

1-5

6-15

15+

 

Do you already have web space and a server to host your website? (i.e. is your internet provider giving you space or will you need us to set you up with web space?)

I have space for my site.

I would like FREE web space on the internet.

I would like a domain name with a paid host.

Not sure, please send me more information about this.

 

Will you need any forms, CGI or Java scripts for your website?

Yes

No

Not Sure

 

Any additional comments:

 

How did you hear about this site?

Thank you!

You are not obligated in any way by filling out this form.

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