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	Type of design service: Are you interested in e-commerce related services (selling products, accepting payments, etc.) or more general Web design work? * E-commerce related services General Web design services What type of Web site design services are you looking for at this time? * Design of an entirely new Web site Complete redesign of an existing Web site Maintenance or upgrade to an existing site Other (please specify below) Please specify: Information about you: Which of the following describes your business and web design needs? * New business - exploring web design options New business - setting web design budget New business - have web design budget Established business - exploring web design options Established business - setting web design budget Established business - have web design budget Personal Website Will you be providing any of the following content or materials to the Web site design firm? * No - We are looking for help with every aspect of our Web site Yes - We will provide copy/text for our Web site Yes - We will provide images/graphics for our Web site Yes - We will provide layout/site map for our Web site Yes - We will provide audio/music for our Web site Purchase details: Would you like your chosen supplier to handle ongoing Web site maintenance? * Not sure - Please advise Yes - We would like the supplier to handle ongoing maintenance No - We would like a third party to handle ongoing maintenance No - We will handle ongoing maintenance ourselves When would you like the Web design project to start? * ASAP In two weeks In one month In two months What is your e-mail address? * Additional details If you are looking to upgrade or redesign your current Web site, please indicate the URL: Have you already registered a domain name for this Web site? Yes No Have you already arranged for hosting services for this Web site? Yes No Please describe the intended focus of this site and any additional requirements you may have (e.g. advanced features needed such as streaming audio/video, database, secure pages, etc.). ALMOST DONE...Plese provide contact information: First Name: * Last Name * Company Name: Industry: * Advertising/Marketing/PR Agriculture Biotech/Pharmaceuticals Computers-Hardware Computers-Software Construction/General Contracting Consulting Education Equipment Sales & Services Financial Services Government Healthcare Information Services Insurance Legal Manufacturing Media/Entertainment/Publishing Non-Profit Real Estate Restaurant Retail Transportation Travel Wholesale Other Phone Number: * City: State: * ZIP: