Please take the time to fill out this form to help us better serve you. Give us an idea of what you are looking for, so  that we can give you a quote. We will contact you to discuss your needs further. Please no adult oriented sites. Contact Information Name:   Business Name:   Address 1:   Address 2:   City:   State:   Select StateAlabama AlaskaArizona Arkansas CaliforniaColorado ConnecticutDelaware FloridaGeorgia HawaiiIdaho IllinoisIndiana Iowa KansasKentucky LouisianaMaine MarylandMassachusetts MichiganMinnesota MississippiMissouri MontanaNebraskaNevada New HampshireNew Jersey New MexicoNew York North CarolinaNorth Dakota OhioOklahoma OregonPennsylvaniaRhode IslandSouth Carolina South DakotaTennessee TexasUtah VermontVirginia WashingtonWashington D.C. West Virginia WisconsinWyoming Outside US Zip Code:   Phone:   Fax:   E-mail:   Do You Have A Web Site Now?    Yes or No If So, Would You Like Us To Refresh It?    Yes or No Current Home Page:         Web Package Pages (Pages Average $100.00 and up.) Reminder: Home Page is One page for the introduction of your business  About how many pages do you have in mind, including your Home page? Select OneHome Page Only 2 Pages3 Pages 4 Pages5 Pages 6 Pages7 Pages 8 Pages9 Pages 10 Pages11 Pages 12 Pages13 Pages 14 Pages15 Pages 16 Pages17 Pages 18 Pages19 Pages 20 PagesMore than 20  Select any additional page options that you might want in your web package  E-Mail/Contact Page  Questionnaire Form (like this one)  Guest Book  Feedback Form Links Page  FAQ Page  Data Access Form ($500 & up. Requires Database)  Other Items you might want to add to your site:  Directions Map - A graphical map of your area  Images or Scan Photos (various formats available)  Multimedia effects  Java Script-Scrolling Text  Print and Mail-in Form  Music/Sound Files  Photography  Will You Need To Have Your Site Maintained (regular changes/additions)?  Yes or No  If Yes, how often?   Monthly Quarterly Yearly On Request  Would You Like Us To Host Your Site?  Yes or No  What domain name would you like to reserve?    .com.org .net.info .biz Other  Please describe your business and what your site would be about?    Do you have any other comments?    How did you find us? (Very Important To Us!)