R and D Web Design

info@randdwebdesign.com

605-214-1986

Request Information on New Website Design

Please fill out as much information as possible to ensure an accurate quote.

Do you have a domain name registered? No Yes
Do you have hosting set up? No Yes

If you answered No, please fill out the following:

I request help in deciding on a domain name No Yes
I am considering this for a domain name:

I request help in selecting a Hosting Company for my website: No Yes
I am considering this company to Host my website:

If you answered Yes, please fill out the following:

What is your domain name?
Who have you chosen to Host your website?

Approximate number of pages:
Web Site Focus: Service(s) Product(s) Other

Service(s):
Product(s):
Other Site Focus:

Additional Comments:

Are you interested in Search Engine Optimization? No Yes

Are you also interested in Documet Services (such as Business Card Design to match your website)? No Yes

Your information is held in the strictest of confidence.

First Name:
Last Name:
Title:
Company:
Email Address:
Re-enter Email Address:
Phone:

Preferred Method of Contact: Email Phone

We will contact you as soon as we can with your price quote. If you decide to use us for your web site design, we will put together a contract based on this and any other information we receive from you.