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Web Development Form
WEB DEVELOPMENT REQUEST FORM
Contact Information
Name
*
First
Last
Email
*
Phone
*
Company Information
Company Name
*
Do you already have a current website?
*
Yes
No
Domain Name
*
Would you like us to host your website?
*
Yes
No
Domain Name
*
Please specify some domains in order of preference
Slogan or Tagline
Describe your business
Website Pages and Features
Please select pages you require
*
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Home
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Services
Products
Testimonials
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News
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Client List
eCommerce
Project Portfolio
Image Gallery
FAQ
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Sitemap
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Term of Use
Others (state in comment)
Please select features you require
Additional modules
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Appointment/Booking
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Data Table
Embed Video
Event Calendar
Files Backup
Files Upload
Firewall Security
Forum
Image Slider
Google Map
Media Social Share
Members Login/Register
Members Permissions
Multi Language
Newsletter
Page Caching
Page View Counter
Parallax Scrolling
Payment Gateway
Search
SEO
Others (state in comment)
Design
You want us to design a logo for your company?
Yes
No
Any reference website you have in mind for the design & layout?
What are the colours required for this website design?
Comments
Training
You want attend training to manage website?
*
Yes
No
Please select role you require
*
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Administrator
Editor
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