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  For designing Dynamic interactive web site at affordable rates.
What is the goal of your Web site?
Need a New Web Site
To Re-Design Existing Site		 Need a Host
Have a Host		 Want Domain Name
Already Have Domain Name
Additional Site Requirement Customized Graphics (Logo's)
Audio
Video
Shopping chat		 Search
Security
Scanning
Data Basing
How many graphics would you like your Web site to include?
Number of Pages
If you require E-Commerce capabilities, how many products or services do you plan on offering through your site?
What is the desired live date for the site? Month Day Year
How long will you be accepting responses?
Name  
Email Address  
Conform Email  
Address  
City  
State or Province  
Country  
Phone  



  

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