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Aplus-Computer.com Online-Order-Website-Request-Form
Get Hosting here at ONLY $8.95 /month
Contact Information :
*
Name:
Address:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Phone:
*
Email:
Web Site Information:
Your Current URL if you have one.
*
Is this site for business, personal, etc.?
Site For
Business
Private Party
*
Number of pages you might need.
Number Of Pages
2
3
4
5
5-10
11-15
16-20
21-25
26-30
more than 30
*
Number of images you might have or need.
Number Of Images
1
2
3
4
5
5-10
11-15
16-20
21-25
26-30
more than 30
*
Do you have your own images for the site?
Yes/No
Yes
No
*
Do you want a background image?
Background Image?
Yes
No
Have My Own
Will you be selling any products or services from your site?
Yes/No
Yes
No
Undecided
What type of features will you be needing (guestbook, counter, etc.)?
Is there a site that I can look at that is similar to what you want yours to be? If so, please provide the URL to that site. It is to give me a better idea of what you want to accomplish.
How did you hear about this service?
How You Heard Of This
On This Site
From A Friend
Other
*
Please provide as much details as you can about the site you want built.
