|
Name
|
* |
|
Address
|
|
|
City
|
|
| Country |
|
|
State
|
Us Only |
|
ZIP
|
|
|
Email
|
* |
|
Telephone
|
|
Name
of sales rep. or referrer
(If applicable)
|
|
| Company
Name |
|
|
Project
Duration
|
|
What is the purpose of this web site?
|
Personal
Business
Other
Explain:
|
| Is
this site currently online? |
Web Site: Yes
No
If so, what is your current
URL:
|
| What
are some of the monthly requirement for maintenance? |
Explain:
|
| Estimate
how many pages your site contains. |
|
| Tell
us about this project (Please be detailed). |
|
|
Do you accept payments
for products on your web site?
|
Payments: Yes
No
If
so, who do you accept payments with?
PayPal
Merchant Account
Other
|
|
Estimate
how many pages are updated monthly.
|
|
|
Who
currently maintains your site?
|
|
|
who
currently host your site?
|
Host with National Webworks |
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2004 National Webworks. All rights reserved.