Purchase Request

*Name
*Email Address
*Email (again)
*Company
Phone

Do you currently have a website?		Yes No
If yes, what is the URL?
What primary products and / or services do you provide?

Which best describes your current needs?


List 3 competitor websites and what you like/dislike about them
1. http://
2. http://
3. http://


What are some short-term goals for your site?
What are some long term goals for your site?
Choose your options:
All new designs and redesigns include a $350 design fee. Additional pages / forms are $35 per item and are billed upon completion of the site.
Would you like to edit your website after it is done for $250?
Do you want a class management program for $100?
Do you want yearly web hosting for $75?

Additional comments and/or concerns:


How did you find us?

We will put together a contract and email it to you with deposit information.