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Thank you for considering AJLMEDIA Design & Creative Services for the solution to your creative media needs. Complete the form below to get started and to provide a little background about the web site you'd like to have built.

Not all fields are required. Complete only the information that pertains to your project needs.

contact information
company/name: *
address:
city: 
state: *
zip:
e-mail: * 
contact phone:
other phone:
fax:
how did you hear of AJLMEDIA Design & Creative Services? *  
what is the best means to contact you?
phone
e-mail
fax
project information
what is this inquiry regarding? *  

new site design
redesign of existing site
creative consultation
other media needs
 
please add any additional information:
your web site
existing URL:
description of desired site:
estimated budget: *
time frame requirements:
desired size of site (in pages):
click box to add a maintenance package:
will you require web hosting service? *
type of site (check all that apply)
basic brochure site
e-commerce/shopping
community
other
materials provided (check all that apply)
logo
site copy/text
digital photos
photographs
music/audio
other materials:  
features of site (check all that apply)
shopping cart
PayPal functionality
surveys
bulletin board
guestbook
chat
video
multimedia (flash, etc.)
contact form
mailing lists
calendar
other
list at least two sites on the web
that you like:
describe your target audience:
describe the "look and feel" of your desired site:
your desired visitor response:
 
* required 
 

 

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