704 Logo 704 Media Design, LLC - Internet Identity Solutions™

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Contact Information
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Name:
E-mail:
Company:
Phone:  - 
Current Web Presence
Do you currently have a website?
Yes        No
If so, what is the URL?

If not, is there an open domain name
you wish to obtain and use?

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Website Type
Type of site you are interested in:
 Personal Website
 Business Website
 Corporate Website
 E-Commerce Website
 Non-Profit / Ministry Website
Website Features
Features you may be interested in:
(Check any that may apply)
 Frequently Asked Questions
 Paypal Merchant Integration
 Discussion Board / Forum
 Picture Gallery
 Member's Only Area
 Audio / Video integration
 Appointment Scheduling
 Events Calendar
 File Sharing
 Guest Book / Registry
 Flash Multimedia
 Search Engine Optimization
 Logo Design / Redesign
 Customer Survey
 E-Newsletter / Mailing List
 Site Search Tool
Site Depth
Approximately how many pages will your website showcase?
 Pages
If you are selling products on your site,
approximately how many will you showcase?
 Items
Design Budget
Referral / Concept Sites
Are there any websites you know of that portray the design, layout, or features that you are interested in?

If so, please list them and describe any key features:
Key features that I like:
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