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Last Name:	required
Business Name:
Current Web Site Address (if you have one):
E-mail Address:	required
Phone (including area code):
Tell us a little bit about your business:
Please describe the goal of your website:
Which of the following are available for use in designing the site?	I have a company logo to include. I will provide photos and graphics to use in the site design. I have written content for my site.
Maintenance	I want to maintain my own website with an easy-to-use tool I want web maintenance services I'm not sure - lets talk
Other specifics regarding the design:
If you can, provide one or two examples of sites with designs you like:	Website #1 Website #2
Additional Comments:
How long have you been in business?	New    0-2 years    More than 2 years
Please estimate the total number of pages on your website:	10 or fewer 11 to 25 25 to 50 50 to 100 over 100 I'm not sure
Time Frame	2 to 4 weeks 1 to 2 weeks 1 to 2 months less than a week not critical, let's discuss
Do you need to connect your website to a database?	No Yes Maybe, I need more information
Special Features	Membership with password protection
	Audio/Video Multimedia Presentation
	Credit Card Processing (donations, membership, etc)
	Blog
	Message Board
Search Engine Optimization	I'll do my own keyword research and optimizing I want keyword research and initial site optimization I want ongoing search engine optimization services.
Mailing List Sign Up	No Yes, automatically allow my customers sign up.
Discounts	I want to offer discount coupons
	I want to offer gift certificates

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