DESIGNS BY LAURIE
Laurie Roe - Owner & Designer - 713.854.8664 - Laurie@BeDevious.com
Website Design Request
Please fill out the form below to request web design services. Please include all information and questions so that you recieve the most accurate estimate for your design needs.
Company Contact Information:
Company Name
Contact Name
Email Address
Phone Number
Fax Number
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Domain - URL Information:
Do you currently own a domain address you would like to use for this website?
Yes
No
If yes, what is the URL address?
Type of site:
Personal
Business
If No, Please List some suggestions:
Requested Domain URL addresses:
1.
2.
3.
Please select any of the following:
.com
.org
.biz
.net
other
Web Hosting Information:
Have you purchased any web hosting
Yes
No
IF Yes where was your hosting purchased?
Site Design Information:
Main Colors of site
Color
1.
2.
3.
4.
Pages (Titles) to include in the site:
Page Title.
1.
2.
3.
4.
5.
Please Note: Submitting a text document of any text that will be included in the pages of your site,as well
as any images in digital format is suggested but not mandatory.
What is the main purpose of this site:
Do you have images to include?
Yes
No
Aprox. # of images :
List a few sites that have a design or look you like:
Site URL address.
1.
2.
3.
4.
Describe what you liked about these sites:
details:
Site 1:
Site 2:
Site 3:
Site 4:
Are you interested in Email accounts?
yes
no
aprox. # of email addresses:
Please Select the additional Items you would like included in your site
Flash Intro
Flash Navigation
Animated Images
Slide Shows or Photo Gallery
Video Player
Music or sound effects
Calendar
Contact or Order Forms
Other:
E-Commerce Option:
Do you want to sell products or have a catalog on your site:
Yes
No
Number of items:
What payment options would you like available
Pay Pal
Credit Cards
Check or Money orders
Any additional Information or Questions you may have about your site options or design.
Indicates Response Required
Report Abuse
DESIGNS BY LAURIE
Laurie Roe - Owner & Designer - 713.854.8664 - Laurie@BeDevious.com