WEBSITE DESIGN/HOSTING REQUEST FORM
Business Contact Name:
E-mail Address:
Business Name:
Business Description:
Website:
I already have a registered name
I would like this name registered
Business Address:
Business City, State, Zip:
Business Phone Number:
I am interested in the following Website Design Options:
$
25 One Page Home Page Web Design
$10/page Additional pages/links design
About Us
Products
Services
Events
Contact Us
Links
Other
$5/$10 Convert Word and Excel Docs to an Adobe Acrobat Universal .pdf file
Website Maintenance/Changes & Hosting
$35 billed every 3 months
$65 billed every 6 months
$130 billed Annually
$3/Product Grouping PayPal Shopping Cart
$25/year E-mail Setup
$12/month Web Hosting ONLY
Please add detailed information on anything else you need for your website design
in the following box. We will e-mail back an estimate to you as well as start
on a sample website for you to review.:
