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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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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 |
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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