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Name:
Business Name:
Address:
City:
State: Zip:
Phone: Fax:
Email:
Best way to contact you: By Phone By Fax By Email
Best time to contact you: Morning Afternoon Evening
Please provide as much of the following information as you can so we can better serve your price quote needs.
Business Type: (sales/service)
What is the purpose of the website?
Distribute Information Sell a product or service
Would you like to have your own domain name? Yes No
example: www.yourcompanyname.com
If yes, do you have a desired domain name?
Do you want us to register a domain name for you? Yes No
Would you like us to host and maintain your site after completion? Yes No
Number of pages required (approx. page is 8-1/2" x 11"):
Budget/Range:
Will you supply the text in electronic format? Yes No Some
Number of graphics that you will need us to scan:
Number of custom graphics that you will need us to create:
Additional Comments:
Note: Any quote given from completing this form is not final. We use the information you submit as a starting point to advise the price range you fall into. One of our account representatives will contact you as directed. Only then can all of the requirements be discussed. It is after this discussion that a formal, written quotation will be proposed.
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