Save & Return Account (optional)

New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish. The account you establish is only for this form.

Contact Information

Name: *

Company Name: *

Email: * 🛈

Phone: *

Domain Information

Do you have a domain name? *

If so, what is it? * 🛈

Where is your domain name registered? (e.g. GoDaddy, Network Soultions, 1 and 1) *

If you do own a domain name, please email the username and password to your domain's account to sales@promediallc.net

If you do not have a domain name, HeleMarketing has made it very convenient for you to purchase one for your business. Please go to the URL provided below to purchase your domain name. Once you have finished purchasing your domain name, please come back to this form and provide your domain name in the space provided.

To purchase your domain name, go here: Shop.HeleDevelopment.com

Please provide the domain name that you just purchased: *

Please provide the username and password for you domain's account by emailing them to sales@promediallc.net *

Website Design Instructions

Website LOGO - If you already have a website or business LOGO, Please upload your LOGO here. (please upload the original "High Resolution" logo if you have it.) If not, please try to get it from the person or company that originally designed it.

Website Images: Please upload any images you might have that you would like to be on your website.

Front Page: Please provide at least 1 paragraph that introduces your website visitors to your website. This can be written like an "About Us" that tells about your business. *

About Us Page: Please provide at least 1 to 2 paragraphs that tells your website visitors about your business. This can be the history, what services you provide, employee names, etc.. This can also be the same info you provided for the "front page" *

Contact Us Page: Please provide the following information in the box below:

Street Address, City, State, Zip, mailing address, telephone numbers, email addresses. *

Are there any websites you have seen that you would like to show us that would give us an idea of the kind of layout you are interested in? If so, please put the WWW addresses below *

Website Colors: Please go to the WEBSITE below and pick at least 3 colors that you would like to have for your website and indicate which color would be the "primary" color. Please put the color codes in the box below from the color website.

http://www.w3schools.com/cssref/css_colors.asp

*

Social Media

Do you have a Facebook Page? *

If so, what is the URL to your Facebook Page? *

Do you have a Twitter Account? *

If so, what is the URL to your Twitter account? *

Do you have any other Social Media Accounts, (e.g. linkdin, Google+, Pinterest, ect) If so, please list them below. *

If you do not have any Social Media accounts but would like to have us create them for you, please list below the Social Media options you would like. (e.g. Facebook, Twitter, Google +, etc.) *

Additional Notes

Please use the space below to give any additional information you would like for us to put on your website. *

Enter the word in the image *
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