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A web specialist will call you at your convenience to discus your website.

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First Name Last Name

Business Name Entity Type

Phone Number

Email Address

Do you have a domain name? (

Yes No

Do you have an existing website?

Yes No (If Yes, what is your web address?) http://www.

If you have a website is it currently hosted?

Yes No

Do you have a company logo in a digital format?

Yes No

Do you have a particular color scheme?

Yes No

Do you have a slogan or tag line?

Yes No

Do you have photos you would like published?

Yes No

Do you have products & services content and company information to provide?

Yes No

Would you like to accept credit cards through your website?

Yes No

Would you like your website to be listed on any of the following sites:

Google Yes

Yahoo Yes

Bing Yes

Facebook Yes

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