Mansfield Web Designs
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18 Beech Mtn. Road
Mansfield Center, CT
06250
(860) 456-8304

copyright ©2004

REQUEST FOR INFORMATION

Company/Organization Name:
Your Name:
E-mail:

Please describe your business, organization or profession:


What kind of services do you need? (Check all that apply):

New Web site
Redesign of existing site
Increase search engine visibility, marketing existing site
Maintenance of existing site
Other Web site services

If this is an existing site, what is the address?

http://

What type of new or existing site is it for?
Business Professional Organization Personal Other

What would you like your website to do? (Check all that apply):
Provide company / organization / professional information
Provide product information
Provide customer support, service
Sell products or services
Other

Comments or other information:


If you would prefer to be contacted by mail or phone, please fill in the data below:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Phone number (please include area code):

Work Phone
Home Phone

Copyright © 2004 Mansfield Web Designs. All rights reserved.