| First Name: |
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| Last Name: |
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| Business Name (if applicable): |
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| Email Address: |
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| Phone: |
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| Best time to call? |
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| Street Address: |
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| City: |
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| State: |
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| Postal Code: |
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| Have you already purchased a domain name for your site? |
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| What would you say best describes your purpose for having a web site designed? |
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| Do you have any examples of what you want your finished product to resemble (similar sites, logos, advertisements, etc)? |
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| Please list your competitors web addresses, if any. What do you like/dislike about these examples? How do you wish to distinguish yourself from your competitors? |
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| Where applicable, please list any spacific web technologies you wish to implement into your web site design, (streaming audio/video, flash animation, etc.) |
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| How many separate pages do you wish to have included in your site, (index, information, products, contact, order, etc.)? |
Approx value if "more":
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| Will you be able to provide copy (text) and images (photos/graphics) in a digital format, or will we have to convert your information to digital format? |
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| Do you have any other comments, concerns or special requests concerning your web site or our design services? |
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