Web Design Information Request Form

Please answer the following questions so that we will have all of the necessary information prior to your free initial consultation call. If you have any questions feel free to call us Toll-Free at (800) 929-8611 or local at (703) 753-5755 or e-mail sales@affordablewebdesign.com

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Contact Information

Your Name *:
Your Email *:
Company:
Phone Number:

Project Information

Type of website services *:	Select One... New web site Redesign current website Maintenance or upgrade to an existing website eCommerce Website Search Engine Optimization (seo) Other This is a required field.
If you have a website. please indicate the URL:
How many products (SKUs) do you sell *:	Select One... 0, we are not selling products 1-24 25-99 100-999 1,000-4,999 5,000-19,999 20,000+ This is a required field.
Project Budget *:	Select One... $2,000.00 to $3,000.00 $3,000.00 to $5,500.00 $5,500.00 to $10,000.00 $10,000.00 to $20,000.00 $20,000.00 to $50,000.00 $50,000.00 or more
Domain Name Registration :	Select One... I need a Domain Name registered I already have a Domain Name Not Sure Yet, Please Contact Me
Website Hosting :	Select One... I need Website Hosting I already have Website Hosting Not Sure Yet, Please Contact Me
If E-commerce site. What functionality are you looking for in the design of your eCommerce website?	Bulk uploading of products Catalog search Credit card processing PayPal integration E-mail notification/invoices Inventory management Multiple shipping & sales tax options Order/customer tracking Secure checkout & order processing
Project Start:	Select One... ASAP 1-2 weeks 3-4 weeks 4+ weeks
Other websites that match the design and/or functionality you want for your website :
Please describe your website project. Be descriptive and clear, list all design and/or functionality requirements and additional notes or comments that you feel are important to know in the Quote and design process *:
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