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Information on designing Website / Portal: |
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*Indicates a required field |
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First Name* :
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Last Name* : |
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Email Address* : |
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Company Name* : |
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City* : |
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State/Province* : |
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Country* : |
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Phone Number* : |
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Fax Number :
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Information on the website:
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Is this a new site or a re-design/development?
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Do you have a specific date you would like your project
to be completed? If so, when? Please factor in the time for user requirement prototype
review to final launch e.g.10 - 14 days : |
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Check all that apply : |
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Other, please specify : |
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Estimated number of pages in your website:
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Explain your ideas in as much detail as possible : |
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Describe your business in as much detail as possible : |
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Please provide us with a list of competitor web sites or sites you feel are comparable to your goals : |
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Maintenance Section: |
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How often do you foresee the need to update your website? |
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Other, please specify: |
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What type of changes would you foresee? Please check all applicable : |
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Other changes, please specify:
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How much would you be willing to pay for the web design service?
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