| Your
Name: |
Your
Email Address
(required): |
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| Your
Daytime Phone Number: |
The
best time to reach you: |
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| The
best way to contact you: |
How
did you hear about us? |
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| What
design needs do you
have?: |
General
Information
Basic
Web Site
E-commerce
Web Site
Web
Site Requiring Databases
Redesign
of a current web site -
please provide the URL:
http:// |
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| Please
describe the type of
your business: |
| |
| Please
describe your web site
needs: |
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Please
answer the following
questions if you are
interested in a e-commerce
web site:
How
many Products do you
have?
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| How
often will product
information be updated
on the web? |
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| Do
you want to accept
credit cards on-line
your web site? |
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Yes
No |
| Do
you need on line credit
card authorization and
settlement? |
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Yes
No |
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| Questions
or Comments: |
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