WWWeb Design - Web Site Designer and Hosting

SERVICES

Contact Information

Complete this form or contact robharris@wwwebdesign.net
Phone: 707-328-1578 9-5 Monday thru Friday

Mailing Address:

Rob Harris
1275 Fourth Street #118
Santa Rosa, CA 95404

Your privacy is respected. All information submitted will be kept confidential.

Your Name:
E-mail:
Phone:
Mailing Address:
City: State: Zip:

Web Site
Design/Hosting
Package Desired
see Prices for details

(check one)

$150 1-pg Website & 1 yr Hosting Pkg
$250 5-pg Website & 1 yr Hosting Pkg
$400 10-pg Website & 1 yr Hosting Pkg
Other

Do you have a web site now? Enter URL:

Business/Organization Name:

Main purpose of this site?
(check one)

Social
Recreational
Educational
Religious-
Commercial
Other

Do you need?:

(check all that apply)

Graphics or Logo Design
Dynamic or Active Web Pages
Searchable Database
Data Collection Forms
Mailing List Management
Shopping Cart
Credit Card Processing
Downloadable Files
Streaming Audio or Video

How many pages do you estimate your web site to need?
How many pictures do you initially have for your web site?
What format are the pictures in? Check all that apply. (Depress and hold the Ctrl key to select more than one.)
Do you have text and/or ad copy written for the pages?	Yes No
If so, what format is it in? Check all that apply. (Depress and hold the Ctrl key to select more than one.)
If not, do you need help writing text or ad copy?	Yes No

How do you prefer to be contacted?	e-mail phone

Other Comments:

Thank you completing this form. When finished, click the Submit Form button below.
We will start an outline of your web site needs and contact you.

WWWeb Design by Rob Harris and Associates