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Web/Blog Design Form




Your Name:        

Company Name:  

Email Address:   

Contact Number: (XXX-XXX-XXXX)

Preferred Method of Contact:
email
phone
either

Current site url:

Is this site an addition to your main site? (i.e. blog, news, press)
Yes
No

What is the purpose of this site you wish to have designed?


What type of content would you like to display on the site?

Text:
Yes No

Images:
Yes No

Video:
Yes No

If images are to be displayed, how would you like them to be displayed?


Do you have a domain name registered?
Yes
No

If yes, specify the domain:

Type of Server:    

Server Script:       

Will the site being designed link to another site ?
Yes
No

If yes, please specify the url:


Rate your technical skills from 1-5 (5 being the best)
1
2
3
4
5



Security Code:


      
This may take a moment to process.
IF THE DOMAIN HAS NOT YET BEEN REGISTERED, PLEASE CONSULT US PRIOR TO HOSTING THE SITE.