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Phone: 734.646.1426   /   E-mail:

  User Information:

Company Information:


Company name:

Please describe your company:

Do you currently have a website:

If so, what is the URL (web address):

Who is your host company (URL):



Please list the titles for each of your pages that will be displayed on your web site (E.G. "About Us", "Contact):

What colors would you like your web site to be: (Please provide three choices)

Color 1:
Color 2:
Color 3:

Please provide 3 specific URL’s to websites you like:

URL 1:  
What about the site do you like:

URL 2:  
What about the site do you like:

URL 3:  
What about the site do you like:

What image do you want your website to portray:

Will you provide a logo:

If not, do you need us to design a logo for you:

Please describe what you would like in the logo.

Do you already have image/graphic ready content available for your site:

If not would you like us to provide this for you:

Thank you!!