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Information about you

Your Full Name:	* Name required
Company Name (if applicable):
Email:	* E-Mail required * E-Mail incorrect format
Phone Number:	* Phone required

Describe your project

Launch date:
Is your launch date fixed or flexible?	Fixed Flexible
What type of Web site design services are you looking for?	E-commerce related services Design of an entirely new Web site Redesign of an existing Web site Maintenance or upgrade to an existing site Other - contact me
What is your total estimated budget for this website design project?	£500 - £999 £1000 - £1499 £1500 - £2499 £2500 - £4999 Over £5000 Other - contact me
Describe briefly your dream website: (e.g. Number of columns, color...)
What is the primary purpose of the site? (e.g. To make a sell, to make an inquiry, to show your portfolio...)
How many pages are required? Could you list them all? e.g. Home, About, Portfolio, Contact...
What features do you want on your website?	E-commerce (Shopping Cart) Member Registration and administration Content Management System (CMS) Weblog (Blog) Image Gallery Polls User Forum Detailed Statistics Search Functionality Newsletter Management Event Calendar None Other - contact me
If E-commerce, how many products will you sell?	Less than 50 products 50 to 100 products More than 100 products Don't know yet
Describe if you will provide any of the following content or materials?	We need help with every aspect of our site You can use existing brochures / literature We will provide copy / text for our site We will provide images / graphics We will provide the logo of our company We will provide video / music We will provide other kind of media / files Not applicable Other - contact me
URL of Web sites you like e.g. http://site.com
Additional Comments

Web hosting information

If you are looking to upgrade or redesign your current Web site, please indicate the URL:
Domain Information:	Need to register a domain Already have a domain Don't know, contact me Not appicable
Website Hosting Information	Need help me to find a host Already have a host Don't know, contact me Not appicable
Additional Comments:

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