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Sample Web Page Form

Before we get started on putting your customized sample web page together we will need some information on your business. Please be as clear as possible when describing your business so that we can design a masthead banner that conveys the image you want your customers to see.

Upon completion of your sample page we will e:mail you the URL address so you can view it. If you like what you see and decide to use Awebpage.com to design your site we will require a 50% deposit based on the total estimated cost of your web site / web page before any further work is done. The balance will be due when the site is completed to your satisfaction.

We accept Visa, Mastercard, or American Express as payment for our services.

Please Provide Your Business / Personal Information

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E:Mail Address (required):
Your Full Name: (required):
Company Name:
Street Address (required):
City (required):
State (required):
Zip (required):
Phone No. No Dashes

Type the number of your color choice(s) in this box

Choose a color and type the number in the box above

Please provide some text for the Home Page... this is what you would like your visitors to read about your product or service. Please be clear so we can understand what it is that you are selling, or the service you are providing. Pictures always add some interest to a site so if you have some of your own in a .GIF or .JPG format email them to us and and we will include them in your sample web page.

How many web pages are you contemplating for your site? Think of a page as being a standard 8 1/2 X 11 sheet of paper.
1 2 3 4 5 6 7 8 9 10
If More then 10 Pages type total here:

Your estimated budget: From: To:

Are you looking for a site with bright flashy colors or more on the conservative side:
Yes, Flashy, bright pastels, green, yellow, light blue, pink etc..
No, Business Conservative, traditional colors , dark green, blue, gray, burgundy, black, etc.

Do you currently have a web site that you want updated: Yes No
If "yes" what is the URL address of your web site:

Are you interested in a domain name site ie: www.yourname.com

How would you like to make payment: Credit Card Check

Do you have a Host for your site? Yes No

If "yes" who do you use as your Host:

Do you want to accept credit cards online for payment:	Yes	No
Do you want a form that is filled out and e:mailed to you:	Yes	No
What type of computer are you using to view the Internet:	PC	MAC
Do you have pictures that you would like on your site:	Yes	#	No
Which browser do you use:	MS Internet Explorer Firefox Google Opera Netscape
Who is your (ISP) Internet Service Provider: