The Painted Page

Client Information Request Form

Please fill out this form and we will reply to you soon.


Name:     
Address: 
City:              State:       Postal Code: 
Country:       E-mail Address:

Phone:


Please send me an estimate of cost and time regarding the following:

Lay out and Design
Brochure Flyer Business Card Newsletter Letter head
How many Graphics? How many Graphics? How many Graphics? How many Graphics? How many Graphics?
Client will provide:
Text Graphics
Client will provide: Client will provide:
Text Graphics
Client will provide: Client will provide:
Text Graphics
Text Graphics Text Graphics
Web Lay out and Design
Flash Intro Page HTML Intro page Additional Pages Monthly Maintenance Web Hosting
How many Graphics? How many Graphics? How many Graphics? How many Graphics? I need web hosting
Client will provide:
Text Graphics
Client will provide:
Text Graphics
Client will provide:
Text Graphics
Client will provide:
Text Graphics
I will provide my own:

Original Art work Technical Writing

Please add any additional explanations:

Please contact me: check all that apply
E-mail Phone Mail I will contact you

    
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