InterFlex Technologies Data Collection Form

Please enter your information in the fields below. This information will help us to get started on the specifics of your web page design.

Do you currently have a web page? Yes No

Do you own a domain name? Yes No

Do you want to do e-commerce? Yes No

Do you have a web host? Yes No

Do you have an email account? Yes No

Please enter your name:

Your address:

Your city:

Your State:

Your phone number:(999)999-9999

Your email address:

Best way to contact:

Do you currently have a web page?	Yes	No
Do you own a domain name?	Yes	No
Do you want to do e-commerce?	Yes	No
Do you have a web host?	Yes	No
Do you have an email account?	Yes	No
Please enter your name:

Your address:

Your city:

Your State:

Your phone number:(999)999-9999

Your email address:

Best way to contact: