Your
Name (required) :
Company
Name:
Phone
Number (required) :
E-mail
Address (required):
Estimated Project Start Date :
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2008
2009
2010
Company
Location:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Company
Industry:
Select
Automotive
Construction
Electronics
Financial Services/Accounting
Food/Beverage
High-Tech/IT
Manufacturing
Medical/Healthcare
Pharmaceuticals
Real Estate
Retail
Other/Not Listed
Service
Needed:
New Website
Development Website Upgrade/Redesign/Maintenance
Current
URL:
Size
of Company:
Select
Small Business
Medium
Business
Large Business
Other
Number
of Pages Needed:
Select
1
2
3
4
5
6
7
8
9
10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
More Than 50
Additional
Services Needed:
Ongoing Website Maintenance
Managed Web Hosting
Domain Registration
Database Design
Search Engine Marketing
Real-time Credit Card Processing
Logo Development/Design
Site Statistics
Administrative Interface
E-Commerce/Shopping Solution
Security Features
Search Features
Additional
Project Info:
What
is the purpose of your website?
Select
Sell
Products/Services Online
Marketing
Tool/Lead Generator
Information
Resource/Corporate
Personal
Please
list a couple examples of websites that
you like (optional) :
What
kind of website are you interested in?
Select
Simple,
Streamlined Site
Serious
Stable Site
Exciting
Dynamic Site
Highly
Graphical
Flash
Site and/or Intro
What
is your budget range?
Select
Under $3,000
$3,000 - $5,000
$5,000 - $7,500
$7,500 - $10,000
$10,000 - $20,000
$20,000 - $40,000
$40,000 +
How
would you like to receive your quote?
Select
Microsoft
Word Attachment
HTML
E-Mail
Plain
Text E-Mail
Call Me
Setup
a Meeting
Please give a brief description of your company and tell us more details about your project:
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IMPORTANT
NOTICE! AJT
Design & Marketing, Inc. respects
your privacy and will NEVER sell or distribute
your personal information to anyone, for
any reason. You can rest assured that your personal/business information, including your email address, will be kept in strict confidence.
FREE QUOTE:
407-880-6810
