Contact Information:

 First Name:*      

 Last Name:*      

 Email Address:*    

 Phone Number:        —   — 

 Company Name (if applicable):  

Services Requested:

 Type of Web services needed:*

New Web site
Re-Design existing Web site
Enhance my existing Web site
Maintain my existing Web site

  Do you need a domain name?*   Yes    No

  Do you need Web hosting?*   Yes    No

  Do you need Web site maintenance?*   Yes    No

 Approx. how many pages will your site have?*    --Select one-- 1 to 5 pages 6 to 10 pages 11 to 15 pages more

 How soon do you need your site online?    --Select one-- 1 week 2 weeks 3 weeks 4 weeks 2mos or more

Project Type:

  Purpose of web site (please check all that apply):
   Establish a presence on-line
   Provide information
   Provide service
    Sell products/services online
    Marketing
    Other (please specify)  

Project Specifications:

  Please check the features you are interested in:
   Online application forms
   Searchable data
   Sales with a shopping cart
   Newsletters
   I need a logo
    Other (please specify)  

   Do you currently accept credit cards?
                 No, don't want to
                 No, would like to
                 Yes

  Please include any additional information:

              

  How did you hear about us?       --Select one-- Link from other site Search engine Advertisement Word of mouth Other

Please be assured that Blue Fox Graphics does not sell to or allow any other parties to use or have access to any customer or potential customer information.