Questions?
Call Jack: 574-232-1730
or e-mail:
Support
(please note that * indicates a required field)
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First Name:
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Last Name:
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Business Name:
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Business Street Address:
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City:
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State:
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Zip:
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Phone:
Cell Phone:
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Business Phone:
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Contact E-Mail:
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Please Select the Best Way to Contact You
Phone
Cell Phone
Work Phone
E-Mail
Mail
In Person
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Time Frame for Project
Several Weeks..Please Call
Within the next 2 months. Please Save this Info..
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Do you already own a domain name that you would like to keep?
Yes
No
What is it?
Please list your prefered choices for your domain name.
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Please describe your Target Market, so that we may add other pages that will help you reach these folks.
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Text for "About Us Page". Please include company history and "Mission Statement".
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Do you hold any special licenses or certifications?
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No
Please List
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Are you a nember of any trade or professional organizations?
Yes
No
Please include The Chamber and The BBB if applicable.
Please List
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Text for "Our Services Page", Please describe completely:
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Hours of Operation:
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Payment Methods Acccepted
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Service area
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Email Addresses and Forwards to be associated with the site (like this: John@your site.com--->John @aol.com)
If not to be forwarded skip the---> part.
Other Features (Pages) I would like installed include:
Facebook Page
Blog Page
A Password Protected Control Panel
Google Analytics Installed
Send to a Friend Script
Bookmark This Page Script
An Events Calendar
Photo Gallery
Google Map
HTML Bulk Mailer
A PDF Upload Script to change
Menues or sales flyer on the fly.
There are more features I would like, described below:
Names and/or urls of sites whose look and/feel appeal to you and/or your choice of colors for your site:
