Free Website Request Form

Your Name*:

Company Name*:

Your Email*:

Address*:

Zip Code:

Phone Number*:

Company type*:

Number of employees:

Years running the business:

Type of business:

** Domain names is your website's name. For example our domain name is N2TEN.com

Do you have a domain?: YesNo

** Hosting is the server that your website will be stored in. Its what makes your website accessable to people worldwide!

Do you have hosting? YesNo

if yes, what is your domain & cPanel access information?

Domain name: (please enter valid url)

Username:

Password:

** If you don't have a domain name or hosting yet, we will create it for you. All you have to do is find a cheap price online and we'll price match!

Would you like us to create a domain for you?

** If yes what domain name would you like?

Would you like us to create hosting for you?

What pages do you want on your website?*

Please attach your logo if available

** If you don't have a logo, or if you are not satisfied with your current one, we can create one for you!

Please list some websites that you like:

Why do you like them?

Please list some websites that you DONT like:

Why do you NOT like them?

**Branding guide refers to any fonts,pictures, brochures, or any other collateral related your brand

Do you have a brand guide? YesNo

**If yes you will be asked to provide them so we can design your website based on your branding guide

Any specific features on the website?

**Note that because this is a free service, anything advanced could be provided for an extra fee.

What's your company's mission?

What are your goals from your business?

Where did you hear about our free website program?