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* Indicates required fields. Comments: * * First Name * Last Name * Company Address Address 2 City, State Zip * e-mail * Preferred Phone # Ext. Cell Home Office * Services you need Application Development Banner Ad Creation Co-location (Dedicated, Virtual) Content Creation Content Management System Domain Registration e-Commerce Solutions e-Newsletters Flash and Multimedia Logo Creation Marketing Consulting Search Engine Marketing Search Engine Optimization Seminars Web Design Web Hosting e-Mail List Management If you selected Content Management System (CMS), e-Commerce Solutions, Flash and Multimedia, Web Design or Web Hosting please answer the following questions. Do you have a web site? Yes No If yes, what is the address? Number of Web pages 1-5 11-15 16-20 21-30 31-40 41+ 6-10 Number of products A 1 B 2-25 C 26-50 D 51-100 E 101-150 F 151-200 G 201+ H None If you selected Search Engine Marketing or Search Engine Optimization please answer the following question. Have you worked with another online Marketing Firm? Yes No If yes, please specify the firm If you selected e-Mail List Management or e-Newsletters please answer the following questions. Number of subscribers A 1-100 B 101-500 C 501-1,000 D 1,001-2,500 E 2,501-5,000 F 5,001-10,000 G 10,001-15,000 H 15,001-20,000 I 20,001+ Frequency Bi-Weekly Monthly Other Quarterly Weekly If you selected co-location, please answer the following questions. Number of Servers Rack mounted servers? Yes No Size of Servers (1U, 2U, etc.) Bandwidth (GB/Month) Please provide any additional information that may assist us in providing you an accurate quote. * How did you hear of us? Chamber of Commerce (Please Specify): Newsletter Newspaper Other (Please Specify): Phone Book Radio (Please Specify): Search Engine (Please Specify): Trade Show

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