WEBSITE DESIGN CONSULTATION

Business Name

Primary Contact Name

Business Email

Business Phone

Select an Address

Current Business Website

Current Social Media Sites

Upload Company Logo

Choose File

What products or services do you SPECIFICALLY want to promote?

Please list suggested keywords (if any).

In two or three sentences briefly describe your business.

Do you have specific colors related to your brand or logo?

Who are your competitors?

What is the desired outcome of a visitor arriving at the website? (To leave an email address? To make a purchase? To contact you? To fill out a form?)

Additional feedback/comments:

Signature: By signing below, you agree to a 12-month contract with Premier Media at the price of $199 per month for website services. The contract will begin on the first billing cycle after this agreement has been signed. All websites require a 30-day notice for cancellation.

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