NXWeb Corporation -- Online Rate Quote

Site Design Quote Request Form

Please fill out as much information as possible on this page, and press the "Submit for Quote" button. This information will assist in determining your needs in order to achieve an accurate estimate. Every effort will be made to respond to you as quickly as possible.

Full Name:
Company Name:
Phone Number:	-
E-mail address:
Referred by:	(name & contact info)
Nature/Scope of Work:	Estimate number of web pages:
Please describe what the purpose is for this site: (e.g. advertising, news/information, sales, membership, etc.)
Do you need to have a domain registered for your site? (www.yourname.com)	No, I don't need one I already have one at: Yes, I need a new one: Choice #1: Choice #2: Choice #3:
Please give any more details or special information that might be pertinent to your site.