Your Details:

Surname: ________________ First name: _____________________ Middle Initial: ___

Your Business name: _________________________________________________________

Your Address: _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Business Address: _____________________________________________________
(if different) _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Contact telephone number: ____________________________________________________

Some general information:

Do you currently have a website? Yes No

If yes, what is your current website address? ____________________________________

Do you currently have an e-mail address? Yes No

If yes, what is your e-mail address? ____________________________________

About your new website (domain) name:

What name would you prefer for your domain? (e.g. www.yourdomainname.com)

www.__________________________________________________

If the above name is not available please give 2 alternatives.

www.__________________________________________________

www.__________________________________________________

You will have a choice of suffixes (endings) for your name. Please indicate which you would prefer.

.com .net .org

What will the title of your website be? (This will appear in the blue bar at the top of the screen)
______________________________________________________

E-mail address(es):

What e-mail addresses would you like to be set up? (e.g. anything@yourdomainname.com)

1. _________ 2. _________ 3. _________ 4. _________ 5. _________
6. _________ 7. _________ 8. _________ 9. _________ 10. _________

Design of your website:

Which template design would you like your website to be based on? (Please indicate clearly!)

Number 1	Number 2	Number 3
Number 4	Number 5	Number 6
Number 7	Number 8	Number 9
Number 10	Number 11	Number 12

What is the business title or personal name to be inserted at the head of the page?

_____________________________________________________________

Apart from your home (first) page what other pages would you like on your site?
(These will also be the buttons on the first page that link to your other pages e.g. About us, Contact us, Products etc.)

Page 2: ___________________________________________________________________

Page 3: ___________________________________________________________________

Page 4: ___________________________________________________________________

Content of your website:

Home Page:

What text would you like on your first (home) page, maximum 400 words?
(You may write in the text below, on the back of this page or on a separate sheet of paper attached to this form. Preferably though, type out your text and send it to us on a clearly labelled floppy disk or by e-mail. NB Some of the template designs only allow for a certain amount of words to be entered, please bear this in mind.)

 

 

 

 

 

 

 

 

 

 

 

 

Page 2:

What text would you like on your second (2nd) page, maximum 400 words?

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 3:

What text would you like on your third (3rd) page, maximum 400 words?

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 4:

What text would you like on your fourth (4th) page, maximum 400 words?

 

 

 

 

 

 

 

 

 

 

 

 

 

Photographs:

Please indicate on which page and which position you would like to place your photos.
(e.g. Home Page - upper right. Please mark your photos clearly on the back!)

Photograph Number	Page Number	Position
1
2
3
4
5
6
7
8

Any other information:

 

 

 

 

 

 

 

 

Please sign and date this form below, and send the form, text, photos and deposit payment of 100.00 Euro for value website with no extras (cheques made payable to Peninsula Computer Consultants) to:

Value Website Offer
Peninsula Computer Consultants
Glenview House
Gleneely
Co. Donegal

I have read and agree to the terms and conditions below:

Signed: _____________________________________ Date: _______________________

Please note that by signing this form you are entering into a legal contract.

Peninsula Computer Consultants (PCC) reserves the right to change templates and offer details without any prior notice. All template designs remain the property of PCC and may be used again. PCC retain the right to edit text or images in order to produce suitable websites and any material deemed unsuitable might be omitted. PCC accept no responsibility for inaccurate or libellous information supplied by the customer. Prices quoted are for one year only, an additional reasonable charge will be made for each subsequent year and any changes necessary will also be subject to an additional reasonable fee. Whilst making every effort to promote websites through search engine submissions it should be noted that a high ranking is not guaranteed and PCC accept no liability for a lack of increase of business by a customers' website. Balance of monies is due upon publishing of clients website to the Internet. Please view www.inishowen.biz/templates for latest template designs.