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Name:
Phone:
Email:
What do you do for living?:
How did you hear about us?:
Facebook
Instagram
LinkedIn
Google
Word of Mouth
Something Else
I'd rather not say
What is the size of your business?:
Just me
Family Small Business
10 Plus Employees
50 Plus Employees
100 Plus Employees
Something Else
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Do you have a website?:
Yes
No
Under Contruction
I want one soon!
Something Else
I'd rather not say
How would you rate your online presence?:
1
2
3
4
5
6
7
8
9
10
How would you rate your Social Media Presence?:
1
2
3
4
5
6
7
8
9
10
Do you have your own WWW Domain Name?:
Yes
No
I don't know
I want a new one
Do you have your own domain email address?:
Yes
No
I want one
I want more than one
Select the services that you want:(Select all that applies)
Web Design
E Commerce Design
Upgrade Existing Website
Private Consultaion
Social Media Accounts
Online Ads
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