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Basic Web Design Services Quote & Information Form

Thank you for your interest in having us develop a web site for you or your business. Please fill out the form below as completely as possible. A quote will be generated by our sales team, and will be emailed back to you within 24 hours on weekdays or 72 hours on weekends.

An account executive will be assigned and will be available to you to answer any questions. No one will contact you unless you choose.

None of your information including your email address will be used for any purpose outside of this request. We respect your privacy and hate junk mail as much as you do, therefore it is our strict corporate policy that Scorpion Systems will never sell or transfer your information to a 3rd party.

1. First Name
2. Last Name
3. Email Address -- Required for automatic quote
4. Company name -- If applicable
5. Do you have a current web site?	Yes No
6. If yes please enter address -- i.e. www.scorpionsystems.net
7. Do you currently have a host (server)	Yes No
/. If yes -- What type of host	Windows UNIX Don't know (or other)
8. If no current host, would you like us to give you a quote for hosting services?	Yes No
10. If no to question 5 -- do you have a domain name? We can transfer a domain name to our host for no fee if required.	Yes No
11. Is this quote to update current site or re-create?	Update Current Re-create Current Brand new site not based on current site (or no current site)

Please fill out the appropriate section below:

--If you are choosing to have us update your current site--
Please fill in a detailed description of what you would like to have done. Please be as detailed as possible. We will review your current web page and your comments and will respond back to you.

--If you are choosing to have us re-create your current site --
Please fill in a detailed description of what you would like to have done differently on the new site. We will review your current web page and your comments and will respond back to you.

--If you are choosing to have a new site created-- Also use this if you desire to have new pages added to an existing site
Number of pages that you expect to have created. Check all that apply.	Home page About Us page Links page Other pages (be as specific as possible)
Directions page Policy page Information page Locations page Product page (no E-Commerce) Photo/picture page
Will there be any pages with forms on them? (Like the one on this page)	Yes No

Any comments or special instructions

Would you like a return call for more information?	Yes No
If yes:
Please give phone number
And best time/day to call

Please press or press to start over.

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