Request Form
Bitte füllen Sie alle mit * markierten Felder aus. (Pflichtfelder)

Your contact details
Company
Name*
First Name*
Street / House Number*
Postal Code / Town*
Telephone or Mobile*
Your E-Mail*
Your Website (URL)
How do you prefer an answer

I am interested in a website
(fif not, leave the fields blank)

What kind of website do you wish  
 
 
 
 
 
 
 
 
What kind of websites do you like (sample URL) (Restzeichen: 2500)
Do you have a website or server      
If yes, where an what kind (vServer, Root, GB ?) (Restzeichen: 2500)
You need extra advertising (banner, ads,...?)      

I am interested in something else
(if not, leave the fields blank)

I am interested in  
 
 
 
 
 
 
 
 
 
What graphics, flyers ... do you like (URL) (Restzeichen: 2500)

Project Details

Project name*
Industry
Describe your project (Restzeichen: 2500)

Dates

When should the product be ready Kalender  Format: (tt.mm.jjjj) Uhrzeit :
Project "very urgent" (10% surcharge)      

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