Web Site Request Form

Please fill out this form and include any requirements you have for your web page.

When you click the "Email Form Info" button the form information will be automatically sent by email from you to me. Send any additional information and attachments, such as picture files or pdf files you would like included with your site by clicking here.

The information doesn't need to be perfect or all-inclusive; we will be happy to modify the site once it is up. Simple changes such as background color are free; more complex changes may incur minor charges (our rates are currently $25 per 1/2 hour).

Please submit this form:

Name:
Email Address:
Phone (Optional):

Please tell me what web address you want, example: www.enid-web.com
Show second and third choices in case your first choice is already taken.
Web Address (preferred):
Web Address (second choice):
Web Address (third choice):

The web site will be used for: Business Personal Both

Please indicate method of payment:
Invoice me at this address:
I'm paying with PayPal

Please include any instructions you may have for the layout of the site (optional):

Click this button to automatically email the form information from you to me.