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E-Mail:

Current Web Site URL:

Size:

One Web Page
Web Site (Two or more pages)
     Number of Pages

Web Site Title/Topic:

Logo: Do you have a logo?

Yes
Yes, but create a new one for me
No, but I will create my own
No, create one for me


Web Page/Site Description:

Please give a detailed description of the type of web page
or site that you have [e-commerce, family page(s), etc.]


Host:

Who is your current web page/site host?


Will your web page/site remain hosted there?

Yes
No

If no, would you like:
A free web host setup for you?
A premium web host setup for you?

Graphics: Do you have graphics that you want on your page or site?

Yes*
No, I need you to create graphics
Both, I have some graphics and I need you to create some graphics*

*Your web site consultant will request photographs, product images, logo designs, and other graphics in a .zip file before work begins on your site.

Color Scheme: Do you have a color scheme preference?

No
Yes, retain current color scheme
New Color Scheme:
     List 2 or 3 colors, separated by commas

Deadline:

No, but as soon as possible.
Yes, I need this page/site by date.


Personal Contact Information

Title:

Ms.
Mrs.
Mr.

First Name:

Last Name:



Address:

City:

State or Province:

ZIP or Postal Code:

Country:



Daytime Phone:

Evening Phone:





Alternate Contact:
(If applicable)


Full Name:

Phone Number:




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