Web Page Order Form

Please provide the following information:

First name
Last name
Middle initial
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
Exsisting URL (if applicable)

Type of Site you are looking for: (Check all that apply)
To create a community of dedicated visitors.

To initiate potential customers to make a phone call to a sales rep.

To create a professional online pressence for your business.

To give product and price information to customers.

To have ease of maintenance.

To build up an online reputation using the latest graphic and navigation techniques.

To provide business information, such as store location, hours, etc.

Type of Service you need: (hold Tab key to make multiple selections)
A completely new site Update an exsisting site Monthly maintenance plan

Which pages do you need?
Home/Introduction Research Product/Service detail page Contact Us
Links About Us Mail Order Form Disclaimer Privacy Policy
Feedback Online newsletter Chat FAQ Awards Guest Book
Other

Please check the services you need:
Search engine registration Domain name registration Autoresponder
RealAudio Marketing Plan Custom forms Other

If you already have an exsisting web site what is the address?

Any additional comments or suggestions that will help us to design your site:

- This form is just to give us an idea of what type of page you are looking for...All info will be confirmed before site development begins -