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Your Name (required) |
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Your Company |
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Phone Number (required) |
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E-mail Address (required) |
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Date Service is Needed to Start? |
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Street
Address (required) |
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City Address
(required) |
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Zip Code
(required) |
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Your Industry |
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Service Needed (required) |
New Site Development
Site Upgrade/Redesign |
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Current URL/Web Site
(optional) |
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Size of Company |
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Number of Pages Needed |
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Additional Services Needed:
(required) |
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Site Maintenance
& Updates |
Web Hosting |
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Domain Registration |
Database Design |
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Search Engine Marketing |
Real-time Credit Card Processing |
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Logo Development/Design |
Site Statistics |
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Administrative Interface |
E-Commerce/Shopping Solution |
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Security Features |
Search Features |
E-commerce Options: |
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Will you accept Credit Cards Online?
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Will Your Site Sell Products/Services?
(required) |
Yes
No
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If Yes, about how many items? |
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Multimedia Options: |
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Flash Animation |
Music |
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Video Clips/Feed |
Virtual Tour |
Web Site Info: (Take a minute and think
of the items, products and/or categories you want to see on your
new site.) |
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List any categories that form the main link structure of
your site:
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List any products that form the main link structure of
your site:
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Web Site Definition Info: (This is
information directed to the line of business, sports, sales, etc
that your website will be categorized under.) |
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List some keywords directly related to the area your website will
fall under on the Internet Search Engines:
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Additional Site Info: |
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List a couple examples of sites that you like:
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What kind of site are you interested in? |
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Your Budget Range: (required) |
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How would you prefer to receive your Quote?
(required) |
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Description
Please give a brief description of your company as
well as a
detailed description of your ideal web site and any additional
needs or comments.
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Your computers IP and other info
will be logged to prevent fraudulent usage of this form.
IMPORTANT
NOTICE!
Intellirex Web Design & Hosting respects your privacy and will
NEVER sell or distribute your personal information to anyone,
for any reason. |
