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We understand that it is important that you choose the right Web design solution. Therefore, we would like to help guide you throughout the decision making process. Please fill in the form below and one of our representatives will contact you. Please keep in mind, the more information that you can provide us with, the more prepared we will be to answer your questions. Thank you for considering JRH Web Design & Hosting.

PLEASE FILL IN THE FOLLOWING INFORMATION:
Name:
Company/Organization:
Address:
City:
State/Province:
Postal Code:
Type of Business:
Email Address:
Current Web site, if any:
Phone #:
Best time to call:
I am interested in: Non E-commerce Web Site Design Non Ecommerce Web Site Hosting Ecommerce Web Site Design Ecommerce Web Site Hosting Ecommerce Integration into existing site Update/Revise existing Web Site Web site promotion/marketing Computer services/consulting
What will be/is the purpose of your Web site:
List up to three sites that you find attractive, effective, or functional: 1. 2. 3.
What do you anticipate is your total budget for your project?
< $1000 $1,000 - $1,999 $2,000 - $2,999 $3,000 - $4,999	$5,000 - $9,999 $10,000 - $14,999 $15,000 - $19,999 > $20,000
Other Information:
Referred by someone? We like to thank people for sending business our way. If you were referred by someone, please let us know. If you were referred by more than one person, who most influenced your decision to contact us? Referred by

JRH Web Design and Hosting is a business providing Web site design, marketing and hosting to businesses and individuals through out the Finger Lakes region of New York State including the cities of Geneva, Waterloo, Seneca Falls, Canandaigua, Newark, and Ithaca. In addition to Web site design and hosting, we also provide search engine marketing (promotion) services for new or existing Web sites. We are located in Seneca Falls, NY half way between Rochester, NY and Syracuse, NY.

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