Website Request Form

1

Name

2

What is your level of familiarity with website creation & editing?

Zero. Nothing. Nada. Zippo.

I may have edited a website once. Somewhere.

I make edits to my website and am familiar with terminology.

I work with a web team to have edits made to my site currently.

I'm an expert.

Other

3

Describe "other" below.

4

Do you have an existing website that is NOT through MoxiWebsites?

YESNO

5

Enter the URL for your website.

6

What company do you pay for the domain name through?GoDaddy, Google, Network Solutions, etc.

7

Is the renewal for your current site coming up soon? Select yes if we need to bump you to the front of the line so you don't have to pay renewal costs. This would be in the next month to 3 months. Select no for any other timeframe.

YESNO

8

Have you already set up a website through MoxiWebsites?

YESNO

9

What do you want your URL through Moxi to start with?________________.sites.cbmoxi.com

10

What is your MoxiWebsites url?etc: ReeseJ.sites.cbmoxi.com

11

Please enter links to your social media that you may want to have linked on your website.

12

Please type an updated bio below (less than 300 words).

13

Do you want to include any testimonials on your new website? Please enter them below if so. If not, leave this section blank.

14

Do you want to add page describing your specialty?i.e. military, seniors, relocations, out-of-state, etc.

YESNO

15

Give us as much information about your specialty and why it's important to you below. This text may be slightly edited for web.

16

Is there anything else you'd want to have added to your website that you feel would make a good addition to the Website template?Please describe below.