|| GrafxEmporium || Custom Design Services Request Form ||

:::::Custom Design Services Request Form:::::

GrafxEmporium Web Design Services specialize in the design and development of web sites and graphics at affordable prices while maintaining superior standards at all times! Let us put our creativity to work for you to increase your competitive edge! Because we know your web site is representative of your image, we work closely with every client to design sites accurately representing the quality and service your company or personal site represents. Fees for full site designs will be estimated based on your particular needs and site requirements. If you are ready to move forward with your Internet presence, submit your name, contact information and any details you have available at this time. A free quote will be provided to you once all pertinent information is received. Thank you. Enter your details below: (* Indicates required fields.) Please review our full Privacy Policy.

	* First and Last Name:
	* E-M@il Address:
	• Company Name / Your Title:
	• Telephone Number:
	• City/Country of Origin:
	• Site Name or Future Domain name:
	• Site Url Address:
	• Current Web Host Provider:

Which of the following services do you require? Please check all that apply;
	• Custom Website Design	• Electronic Feedback Forms
	• Site Renovation	• Static or Animated Banner Design
	• Logo Identity Graphic Design	• Award or Badge Design
	• Custom Graphic Design	• Web Hosting
	• Adobe Acrobat .pdf Document Design	• Domain Name Registration


			• Select a WebSet template:
			• Select a WebSet 'Pro Series' template:
			• Select 1 License Option from the 5 options:
			* Projected Timeframe:
			• Estimated number of pages:
			• Estimated budget:
			* Please select a platform:


Yes No	• Is customization required for your webset?
Yes No	• Do you have any text that is ready for use on the web site?
Yes No	• Do you have an outline or plan for your web site?

• Please enter a brief site description, Feel free to leave or ask any questions that you may have.


		* Age Verification: If you are under 13 years of age, a legal guardian is required to e-mail or fax their consent & signature in addition to this request form.
		* Select Yes or No agreeing to Grafx Emporium's Terms of Use & Service Terms.

• Click the SUBMIT button only ONE time.
• Click the RESET button to reset the form to blank fields.

If your browser does not support forms, you may send your request via E-mail Please provide ALL of the above information in your request. Payment information [if applicable] will be e-mailed to you. Keeping your personal information private is vitally important to us. As with all personal information, GrafxEmporium will never rent, sell or disclose your personal information. Please review our full Privacy Policy.

By submitting this electronic form you are acknowledging your agreement to our Terms of Use and attesting to the accuracy of the information contained within your submission. If any terms or policies are found to be violated or false statements made in your application or site after receipt of any of our files, we reserve the right to retrieve our graphics and a 72 hour window of opportunity is granted for you to remove our content from your site/s. Non compliance will immediately result in serious legal repercussions.

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