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Please read this page carefully and fill out all necessary options that will help expedite a respond to you and your order. Required field *
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Company Name:
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First Name:*
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Last Name:*
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Street Address:*
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Apartment, Suite:
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City, State:*
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Zip-Code:*
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Main Phone:*
(ex. 000-000-0000)
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Alternate Phone:
(ex. 000-000-0000)
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E-mail:*
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All fields below are optional, but the more information provided the better to serve your needs.
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- Additional Options (check all that apply)
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Target Audience:
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Will you supply a logo?
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Yes No
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Approximate number of pages requested?
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Have a preferred color scheme?
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Approximate site due date?
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Have a pre-existing web site? (domain name - ex. www.YourName.com)
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Yes No
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a. -
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If yes, what is your web site address (domain name)?
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b. -
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Is your web site (domain name) on a Windows or UNIX/Linux server?
Windows Unix/Linux Not sure
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c. -
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If no, will you need me to supply a list possible of hosting companies?ª
Yes No
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Need a registration page with a database for collection of information?
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Yes No
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Have any photos you want placed on the site?
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Yes No
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a. -
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If yes, do you own the legal rights to your photos?
Yes No
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b. -
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If no, are you willing to pay for photos, from a photo service? (pricing varies)
Yes No
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List special directions, comments, features or other web sites you have seen that you like and may want similar look:
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It is recommended that all text be supplied in Word (.doc) or Text (.txt) format. This will expedite the process, if I must retype or OCR-Scan any pages, there will be an additional charge of $20.00 per double-spaced page, or $30.00 per single-spaced page.
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Client Name:*
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Date:*
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(MM/DD/YYYY)
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All monies are in U.S. ($) dollars.
¹If you require one or more pages to have a separate design that is an additional charge. Price: $75.00 per additional design.
²It is the buyer's responsibility to find a hosting company. However, I can suggest several duane.media preferred companies and help setup an account with the chosen company. Price: $50.00 per domain
³Cost may vary, depending on size of on-line store.
ªduane.media is not responsible for any hosting company payments or future possible technical difficulties.
¤Additional mock-ups available per package, added fees apply.
Upon agreement of the conditions and price - half the balance is due before any work will begin, the balance remainder is due upon completion and approval of the site. If site is done in phases, each complete phase payment is due before the next phase will begin.
Note: All prices subject to change without notice.
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814.8724 travis@duanemedia.com
