Helping Place People And Their Businesses On The Internet.		 Internet Services
Effective Web Presence And Promotion.

Pricing & Information Request Form

In order to supply you with specific pricing & information pertaining to your needs
please fill out the information fields below.

Please describe the type of business you would like to have a Internet presence for

Commercial Services
Residential Services
Home Based
Entertainment
Medical		 Publishing
Travel
Financial
Real Estate
Other (please describe)

Other (please describe)

Let us know a little bit about your business and what you'ld like to achieve with a Internet presence.

Are you collecting information for...
An upcoming product
A pending schedule of an existing business
Conducting research
Other (please describe)

How familiar are you with the Web?
Very familiar Somewhat familiar Not familiar at all

Would you like information sent to you by...
Email Postal Mail Phone Fax

What time of the day / day of the week - would it be best to contact you?
Home Or Work

Would you like to receive periodic updates on our services?
Yes No

Are You...
With an ad agency
Gathering information for your own business
Other (please describe)

Full Name:
Date :
Mailing Address:
City: State: Zip:
Home Phone #:
Work Phone #:
E-mail Address: