Request for Custom Web Development Proposal: Karen's World of Design || Chattanooga, TN

Chattanooga's Finest in Web Design & Hosting

REQUEST FOR INFORMATION

If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: info_request@karensworld.com or give us a call at (423) 499-9849. Please double-check your email address if you want a reply.
^* Indicates Required Field

PERSONAL INFORMATION:
Name: ^*	Required
Company: ^*	Required
Address:
City:
State:
Zip:
Telephone: ^*	Required
Email: ^*	Required
Site URL: [If you have one]
SERVICES REQUESTED [Check all that apply]
Domain Registration	Web Design
Hosting	Merchant Account
Shopping Cart	Site Maintenance
Web Package Desired:
ADDITIONAL FEATURES DESIRED [Answer as closely as you can...]
Feedback Form	Event Calendar
Javascript Order Form	Slideshows
E-Mail Autoresponder	Database
MP3's, Real Audio	Newsletter Subscription
Other: (Please Specify)
DOMAIN / HOST INFORMATION
Do you own a domain? {www.yourname.com}
If you have no domain name registered, please list 3 choices:
Will you be needing server space (i.e. a host account)? Yes No
Please call me to discuss my needs. Yes No
Are you at least 21 years of age or older?^* Yes No Required
Please describe what you have in mind so we may get an idea for your page. If you have seen other sites that you particularly like the design, please refer them to us. * Check here to indicate your agreement to our Privacy Policy. All information submitted will be kept strictly confidential. [ By submitting this information, you agree to our Terms of Use \| Privacy \| Disclaimer ] Please hit the "submit" button only once! You will then be returned to the home page. Thank you....

In the meantime, if you wish to have info emailed to you, please do!!
info_request@karensworld.com

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Karen's World of Design · Chattanooga, TN 37421 · 423.499.9849 ·