WordPress Website Creation Client Contact Form

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

CLIENT CONTACT FORM

Please complete this form AFTER you have submitted your signed Website Proposal/Agreement & made your complete payment.
Your Personal Information

Your Name: *

First

Last *

Last

YOUR Phone Number: *

YOUR Email: *

Your Domain (www.YourDomain.com) Information

YOUR Domain Name: *

What Company Is Did You Register Your Domain With? *

This is where you got/registered your domain.

Domain Registration USER NAME: *

Domain Registration PASSWORD: *

Domain Registration Call In Pin:

(if applicable)

WordPress Website Hosting

What Company Is Hosting Your WordPress Website? *

Website Hosting Login USER NAME: *

Website Hosting PASSWORD: *

Website Hosting Call In Pin (If Applicable):

Business Content For Your Website:

Business Name: *

Business PHYSICAL ADDRESS: (If needed):

Business MAILING ADDRESS: *

Business PHONE NUMBER: *

Business FAX NUMBER (if applicable):

Business EMAIL ADDRESS: *

Basic 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. *

Website Time Period

60 Day Creation Period. *

I understand that work will not start until a complete payment is received. Once a complete payment is receive this will start the 60 day “clock” for completion.

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