We would like the opportunity to earn your business!!

If you have considered:

• Developing a web site to be placed on the Internet
• or Changing web hosting providers for your current site
• or Learning how a web site can be beneficial to your business....

We have the solutions for you !!

1. Personal Information     Name:        Organization:        Title:        Address:        City, State, Zip     ,      Country:        Phone:        E-mail:        How would you like to be contacted? Choose One by Phone via E-mail

2. Services to Inquire      Internet Access - Individual      Internet Access - Business      Web Site Hosting      Web Site Design Services      Domain Name Registration      E-Mail Services (standard with all hosting and access contracts)      Web Graphics Design      CGI Programming      Shopping Cart Programs      Secure On-Line Transactions     Others?

3. Additional Information

Do you have a web site currently posted, or ready to post, on the Internet? Choose One Yes No N/A

If applicable, please list the URL:

Do you currently have a registered domain name(s)? Choose One N/A Yes No

How much web storage space will you require? Choose One N/A less than 5 mb 5 mb to 10 mb 10 mb to 20 mb greater than 20 mb

How many E-Mail addresses would you require? Choose One N/A less than 5 5 to 10 10 to 20 greater than 20

Please tell us any other information you feel would be helpful to us: