| General Information |
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Referred By :
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If you choose Other, You have to indicate here.
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Your Full Name :
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*
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Postal Address :
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| State : |
*
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| Country : |
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Telephone Number :
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*
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Other Telephone Number :
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Fax :
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Email :
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*
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| Business Details |
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Business Name :
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Type of Industry :
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You have to mantion, when you select Other Category
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Type of Business :
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Type of Product/Service :
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Who are your Customers :
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| Design Requirements |
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If you have a template design in mind please input the number here :
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Do you required a ' New ' web site or "Redesign" of an existing site :
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*
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If applicable, what is your current web address :
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Example:(http://www.example.com/html/index.php) |
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How many pages you required :
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How many External Links would you require :
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Give us a List of your
Competitors web sites or sites
you want to look like here
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http://www.
http://www.
http://www.
http://www.
http://www.
http://www.
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| Services :
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Scanning
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Flash
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Animation
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Sound
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Script
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Database Programming
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| Web Forms
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Guest Book
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On-line Marketing
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| Forum
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Shopping Cart
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Credit Card Transactions
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| Web Hosting
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Site Maintenance
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Domain Name/Web Address
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| Select All |
| Any service if you require : |
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What is your budget :
Enter Other Budget Amount :
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What is your time frame :
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Enter Other Frame :
Please provide any other information you think might be useful
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