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Name
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* |
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Address
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City
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| Country |
|
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State
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US Only |
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ZIP
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Email
|
* |
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Telephone
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Name
of sales rep. or referrer
(If applicable)
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I
am interested in
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* |
|
Project
Time frame
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Project
Budget
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to
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What is the purpose of this web site?
|
Personal
Business
Other
Explain:
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| Do
you currently have a web site? |
Web Site: Yes
No
If so, what is your current
URL:
|
| List
some site that are similar in design to what your looking
for. |
|
| Estimate
how many pages your site will contain. |
|
| Please
list the menu items for your web site. |
|
| Tell
us about your project (Please be detailed). |
|
|
Do you want to accept
payments for products on your web site?
|
Payments: Yes
No
If
so, who will you be accepting payments with?
PayPal
Merchant Account
Other
Undecided
|
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Do
you need a domain name?
|
Yes
No
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Do
you need web hosting?
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Hosting: Yes
No
If
so with who?
National Webworks
Other
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Do you need site maintenance?
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Yes
No
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2004 National Webworks. All rights reserved.