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 WEBSITEThe 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 LOGINSPlease 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. * YesPrint this page Captcha If you are human, leave this field blank.