Please be sure all information is correct before you hit submit!

Your Name:

Name of Business:

Your E-mail address:

Business E-mail address:

Telephone # where you can be reached:

Best time of day to call:

Street:

City:

State:

Postal Code:

Country:

Province:

How did you find my website?

I am interested in: Personal Page Business Page

My website will require:

1 2 3 4 5 6 7 8 9 10+ pages

My website will have photographs: Yes No

How many?

1 2 3 4 5 6 7 8 9 10+

I have a preference for a background: Yes No

If yes, please give the url for the background. Be sure you have the correct url and specify the # or name of the background:

Background URL:

If no, describe briefly what you would like for a background (solid color, floral type, brightly colored, etc.)

My website will require regular maintenance or updating of information?
Yes No

How often and what type of maintenance or updating will be necessary?

I wish to have animated graphics on my website. Yes No

If yes, please indicate what type of animation you are interested in:

I would like my site listed with search engines? Yes No

Please prepare a basic rough draft of what you would like on your site as far as text information (250 words per page) and any other information you want on the site (Please hit return when you reach end of box)

I would like the following installed on my website:

If you wish to have a counter/tracker installed, would you prefer a visible counter or invisible counter?

My isp (server) allows space for a website: Yes No

If yes, please indicate your server's url:

Do you have have a domain name registered? Yes No

If you have a domain name registered, please indicate the url for it and the hosting server: