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Website Design Request Form
Share your requirements with us.
10
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1
Name
*
This field is required.
First Name
Last Name
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2
E-mail
*
This field is required.
example@example.com
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3
Mobile Number
*
This field is required.
Allows Instant Message Communication
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4
Your Organisation Name
*
This field is required.
Helps with URL selection
Use your own name if not applicable
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5
Focus of Website
*
This field is required.
Helps with template selection (if applicable)
Please Select
Event Marketing
Product Sales
Education Delivery
Information/News
Portfolio Showcase
Other
Please Select
Please Select
Event Marketing
Product Sales
Education Delivery
Information/News
Portfolio Showcase
Other
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6
Choose Items for the Navigation Bar
*
This field is required.
Home
About
FAQ
User Guide
Forum
Blog/News
Pricing
None of above
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7
More Navigation Bar Items
(optional)
Each item on a new line
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8
Other Websites that caught my eye
(optional)
example.com
example.com
example.com
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9
Additional Services Required
*
This field is required.
Database Connection
Landing Page Design
Banner Design
SEO
Video
Analytics
Website Maintenance Training
None of above
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10
Additional Comments
(optional)
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