Please fill out this form as completely as possible then hit the submit button. You will receive a response in 24 hours.

Payments

Once you except the quote, you will be given a contract to sign. My fee structure is outlined below:

• A down payment of 25% to start the project
• Half of remaining balance once project is completed
• Final payment due prior to upload and launch

If you have any questions about anything on this form please email me at [email protected] 

Contact Information

Company Name:
Contact Name (required):

Email address (required):

Physical address:

City, State, Zip:

Phone number:

Fax number:

How did you hear about me?

Search Engine
Friend
Website
Saw your work

Your Company's Needs

Do you currently have a website?

Yes
No

Is your current website or the website you wish to have designed of an adult nature?

Yes
No

If you currently have a website, what's the URL?

What is the desired completion date of your website?

Total number of pages for your site:

Do you have an existing logo?

Yes
No

Do you have existing content written for your website?

Yes
No

Do you have the existing images/graphics for your website?

Yes
No

Do you want streaming audio or video for your website?

Yes
No

If so, how many pages?

What is the overall impression you want to give your visitors?

Sense of humor/fun
Professional
Elegant/High Quality Merchandise
Sex/Adult Related Material

Hosting & Domain Information

Do you have a host for your website selected?

Yes
No

If so, what is the name of the hosting company:

Do you have your domain name purchased?

Yes
No

If so, what is the registrar's name:

What are some keywords you would like me to use when submitting your website to the major search engines. Try to use words that are related to your industry/business but that are words the general public might use to find it.

Any comments or questions?