QUOTE REQUEST        

Check which applies, Quote or Order

YOUR CONTACT INFORMATION 

(All fields marked with * required)

Your Name:          *

Company Name:  

 Your Email:           *

 Phone No:              State:      Country:    *    

Note: You must be 18 years or over to submit this form, since legal contract for services will be signed between us, should you choose to utilize these services.

 Age:       I am 18 years and over    *

ABOUT YOUR BUSINESS

Describe your business type:                    

Describe the purpose and intent of site:

Describe your target market:                 

Is there any other information you feel we should know in order to provide you with an accurate quote?                   

SERVICE REQUIREMENTS

Website Design

(Check which options you require)

  New Website                        Re-design existing website                         

                                            URL of existing website: 

                                                     Desired Changes: 

 Do you have any preferences for the look and feel of your site? (e.g. colours, backgrounds sample URL's)     

Do you require: (Check which options you require)

Catalogue style Website         E-commerce/Shopping Cart style Website

Interactive Form/s                  Flash components

Number of Pages required (Choose on option)      1-3 pages 4-6 pages 7-9 pages 10-13 pages 14-17 pages 18-25 pages 26-40 pages

Domain

Do you have a domain name reserved? (Check which option you require)

Yes, my Domain Address is:  

No, please provide domain registration for me.

 I nominate the following name/s:     

Hosting

Do you require Hosting?  (Check which option you require)                     Yes,         No

Website Maintenance

Do you require Website Maintenance? (Check which options you require)

No, I do not require maintenance.       Yes, I would like regular Website Maintenance   

   How Often? Weekly       Monthly     Other

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