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General information |
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Referred by:
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Your
Full Name
(*Required fields)
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*
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Postal
Address:
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*
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Telephone Number:
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*
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Other
Telephone Number:
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Fax:
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Email:
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*
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Business Details |
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Business Name:
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Type of
Industry:
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Type of
Business:
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Type of
Product/Service:
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Who are your
Customers:
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Design Requirements |
If you have a
template design in mind please input the number
here
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Design templates area -
click here |
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Give us a
list of your competitors web sites or sites you want to look like
here.
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http://www.
http://www.
http://www.
http://www.
http://www.
http://www. |
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Do you require
a 'New' web site or 'Redesign' of an existing site:
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* |
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If applicable,
what is your current web address:
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How many pages
you require:
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How many
external Links would you require:
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Do you require
a Company Logo:
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To the best of
your knowledge do you require any of the following:
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Web Graphics |
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Scanning |
Flash |
Animation |
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Sound |
Scripts |
Database Programming |
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Web
Forms |
Guest Book |
On-line Marketing |
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Forum
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Shopping Cart |
Credit Card Transactions |
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Web
Hosting |
Site Maintenance |
Domain Name / Web Address |
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Do you require
any other services:
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Print Work (such as stationery, brochures, flyers,
etc.)
CD ROM
Business Cards
Business Cards |
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What is your
budget:
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If you choose other or have a set price in mind, please
indicate the amount here
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What is your
time frame:
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If you choose other or have a set date/time frame in mind, please
indicate the date here
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Comments:
Please
provide any other information you think might be useful.
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