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First Name:

Last Name:

E-mail Address:

Phone Number:

Do you currently have a website?

Yes No

If so, what is the URL?

If not, what domain name would you like? (Depending on availability)

(example: www.google.com)

What is the name of your website or business?

Please tell us the sections you would like your site to have:

Enter your sections in here seperated by a comma.
ie: Home, About Us, Services etc.

Do you currently have content for all of your pages?

Yes No

Do you have any particular images you'd like to use?

Yes No

Would you like a quote form or inquiry form integrated?
(Example: what you're filling out right now)

Yes No

What kind of colors would you like to use?

Do you currently have a logo?

Yes No

If no, would you be interested in purchasing one at a discounted package price?

Yes No

Are there any sites that you particularly like? If so, please enter the URL:

What is your primary reason for wanting a website?

To publicize my services.
So customers can find me on the internet.
To collect customer information.
For self promotion.
For a new business venture.
Other

Please describe in detail what you'd like to accomplish with your website and any other details we may have missed:

Will you also be hosting the site with us?

Yes No

What is the best way to contact you?

Phone E-mail

If by phone, when is the best time to call?

(Please include your time zone)

If you have already talked with somebody in sales, who is it?

We will call or e-mail you within 24 hours excluding weekends.
If you have any additional content to submit, please e-mail it to sales@nuvowebsites.com

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