Contact

Contact Christopher Merrill Web Design

Phone: 773.755.2536
Fax: 773.409.5411

3600 North Lake Shore Drive
No. 523
Chicago IL 60613

E-mail: info@christophermerrill.com

Web Design Request Form

* Your Name:
Name of your business:
* Your contact E-Mail Address:
Confirm E-mail Address:
Your Business Phone:
Your Home Phone:
Nature of your business:
Domain name(s) you own (if applicable):
Time frame for completion of project:
URL for the host with which you have registered (if applicable):
Please list the URLs for a few of your competitor's websites:
Please list a few URLs for websites whose designs you admire:
Do you have images/photographs that you would like to include on your Website? If so, please describe them.
Do you require e-commerce?	yes no
Do you have a company logo?	yes no
Will your website connect to a database?	yes no
Please describe any special features you would like your Website to have:
Additional comments/questions:
How did you find out about us?:
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