Imaj Website Design Services

Request for Information or Web Design Services

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: info@webimaj.com.

If you would like to request web design services, a quote, or additional information, please fill out the form below.

Name:

Company:

Address line 1:
Address line 2:

City:

State: Zip:

email:

Voice Phone: Fax Phone:

I am writing for (multiple items may be chosen):
Request for quote
Information
other

Please enter comments or questions in the box below. If you are requesting information or a quote on our web design services, please fill out the entire form.
General Comments:

Which web design service are you interested in?

Personal WebPage
Junior WebSite
Senior WebSite

Please describe the general nature of what you want to present on your webpage or website. (i.e. personal information about me, promote awareness of my company or my cause, etc. In other words.. what do you have to offer people via the internet?)
Site description:

Do you have a specific theme or colors in mind for the overall look of your website? If so please describe below.
No, I would like you to suggest some creative ideas for the appearance of my website.
Yes, this is what I have in mind for my website's theme:

How many pictures and/or graphics do you need scanned for display on your website?:

Do you already have space on a server to host your website? (i.e. is your internet provider giving you space or will you need us to set you up with web space?)

I have space for my site.
I would like you to set me up with one of the FREE webspace providers on the internet.
I would like you to set my site up on a server that offers website space at an additional fee. I understand that thru this service I can get addtional features such as my own domain name (i.e. www.myname.com), CGI scripts, extra email accounts, and other options which may have additional fees.

Will you need any custom forms, CGI or Java scripts for you website?

Yes
No
Not sure

Please provide any additional information that may help us in determining how we can best serve your web design needs.
additional information:

Thank you for inquiring about imaj web design services. By filling out this form you are simply requesting information from us and you are not obligated in any way. We will respond to your request within 48 hours. If you do not hear from us within 48 hours, please email us directly at info@webimaj.com. Occasionally some browsers do not support forms very well, and we may not have gotten your submitted form.

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