Service Request

Now offering Nationwide Dial-up

In order to provide you with individualized service, please complete and the following information.
We will contact you as quickly as possible, usually within 24 - 48 hours (except holidays and weekends).

Domain Name

I already have a domain name
I need to have a domain name registered for me

Domain name(s) desired:
2nd choice
3rd choice

Hosting (Please check the following services you need in your hosting package:

I am interested in hosting only
I am interested in hosting and web site services
I will be selling products from my site and will need a shopping cart
I will be collecting sensitive information from my web site and will need a digital certificate
Other (Please explain)

Design:

I need a brand new web site
I would like you to review my existing web site
I need a complete redesign of my existing web site
I am happy with my current web site

Maintenance:

I need someone to maintain my existing web site
I need someone to design and maintain a new web site

Search Engine Optimization and Promotion:

I am promoting my web site myself and don't need promotion services
I need my site optimized for the search engines
I would like assistance to get linked with related web sites
I need someone to handle all of my online activities so I can concentrate on operating my business

Other:

I am doing my own maintenance and promotion but would like someone to guide me along the way
I would like you to review my existing site and offer suggestions for improvement
I would like a monthly summary of my web site performance
I would like to start a newsletter

The following is required:

First Name:

Last Name:

Company Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone Number:

Web site address:

E-mail address:

Preferred method of contact:
	Phone: AM PM
	Time Zone:
	Please contact me by email

Comments (Please provide any additional information that will assist us in preparing your Proposal)

What does it mean to be an iCop(TM) Member? It means that I uphold the strictest business practices and require the same of my clients and the companies of whom I am a client. It means I stand accountable for everything I do in my business.

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Clearwater Web Solutions 320 Michigan Ave. Suite #306, PO Box 408, Orofino, Idaho 83544
Phone/Fax: 208-476-4549 Email: info @ clearwaterwebsolutions.com
Office Hours 9am - 5:30pm Monday to Friday Pacific Time
Evenings and weekends by appointment