SWD Application

If you are interested in having Scorpion Web Designs manage your website, please fill out the information below and we will get back to you soonest. If you have any problems with this form, please contact egaudrea@pacbell.net  

Required Information:

First Name:
Last Name:
Company:
Address:
City:
State:
Zip:
Country:
Business Phone:
Fax:
E-mail:

Is this an application for design services or an inquiry:  Application Inquiry

If you are applying for web design services with SWD, please fill out Section One. If this is a simple inquiry, go to Section Two.

-----Section One-----

What type of website are you planning:

Commercial:   Informational:   Internet Store:   Personal:   Non-profit:  

Do you have a domain name:  Yes:   No: 

If yes, please indicate you domain address:

If not, what domain name would you like:

Please indicate your choice of at least three (3) domains in order of preference, and the extension you prefer:

Domain names can be anything from the name or initials of your business to your name or a simple word. Keep in mind that the more simple, yet unique it is, the easier if will be for your customers and friends to remember it. (E.g., thebar.com, wheatgerm.net, themint.net, kidney.org, etc. It must be in all lowercase.)

Extentions available are .com, .net (both for commercial or personal accounts), and .org (for non-profits, clubs, and other service organizations.)

1st choice:
2nd:choice:
3rd choice:

IMPORTANT Billing Notice

Domain names are registered with InexpensiveDomain and cost  $15.00 per year. InexpensiveDomain will bill directly at the address indicated above.

SWD services are billed on completion of work and are due on receipt.

-----Section Two-----

Inquiry or additional comments: