Client Contact Form

Please complete this form AFTER you have signed your Website Proposal/Agreement.

CLIENT CONTACT FORM

YOUR PERSONAL INFORMATION

Your Name: *

First

Last *

Last

YOUR Phone Number: *

YOUR Email: *

YOUR Domain Name: *

INFORMATION FOR YOUR WEBSITE

The information below will be used on your website and potentially viewable to the general public. If category is going to be not used – please put NOT USED

Business Name: *

Business PHYSICAL ADDRESS: (If needed): *

Business MAILING ADDRESS: *

Business PHONE NUMBER: *

Business FAX NUMBER (if applicable): *

Business EMAIL ADDRESS: *

Business PAYPAL EMAIL ADDRESS (if applicable): *

WEBSITE DOMAIN AND HOSTING LOGINS

Please ensure that there is not a TWO STEP verification active on your accounts. The Domain Registration and Website Hosting MAYBE the same account.

DOMAIN REGISTRATION INFORMATION

Domain Registration Account LOGIN URL: *

Domain Registration USER NAME: *

Domain Registration PASSWORD: *

Domain Registration Call In Pin (If Applicable):

WEBSITE HOSTING INFORMATION

Website Hosting Account LOGIN URL: *

Website Hosting USER NAME: *

Website Hosting PASSWORD: *

Website Hosting Call In Pin (If Applicable):

WEBSITE DESIGN INFORMATION

Colors I like to see on my website are: *

Colors that I don’t want on my website are: *

GOOGLE FONTS that I would like used on my website *

https://fonts.google.com/
If no preference - please state so.

Please list three - five websites URLs that you like. *

I understand that once I receive a written quote it is good for thirty days from the date of the quote and I also understand and acknowledge the Quote Process and that information will be sent to me via email. *

Yes

Captcha