| Name: |
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| Email: |
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| Phone: |
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Company Name: |
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| Type of Business: |
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Size of Business: |
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| How did you hear about us? |
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Search Engine
Which
Search Engine?
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Personal Referral
Who
referred you?
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Other Website
URL
of website:
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Other
Please specify:
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| I am interested in building a website: |
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I have an existing website to modify
or redo: |
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If you have a website, what is the URL: |
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| What is the current priority
for your website? |
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What do you want
the site to accomplish?
(Check all that apply) |
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Sell products or services directly
Present info to potential clients
Develop a qualified list of prospects
Get new customers to contact us
Test for new product niches
Improve overall customer service
Make available product info
Inform customers of updates |
| Approximately how many pages
will your website be: |
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| If you are planning to sell products,
approximately how many will you offer? |
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| What is your web development
budget? |
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| Comments: |
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