C & J Professional Services
Web Design Request Form
Provide name of business or organization for your Website:
Has your domain been registered yet?
Would you like CJPS to register your domain?
Would you like us to host your site?
List the primary and secondary colors for your site:
How many email accounts would you prefer?
List the name(s) of the email accounts you would like set up:
Select the Web pages you would like for your Website:
1 - Homepage
2 - About Us Page
3 - Services/Products Page
4 - Online Ordering
5 - Blog Page
6 - Online Form Page
7 - Calendar Page
8 - Events Page
9 - Picture Gallery Page
10 - Testimonial Page
If you have selected other, please list other pages you want added to the site:
Do you have camera-ready images:
Would your like pictures taken from a professional photograhper?
Explain purpose of your Website:
What are the primary goals of this product?
What type of audience are you aiming to capture?
Upload text files for your Website:
Logos, Photos or Other Graphics:
List any sites you have seen that will assist us in evaluating your competition or designing your site:
Additional information you would like to add:
Should be Empty: