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66013 Avenida Barona
Desert Hot Springs, CA   92240-1601
Direct: (760) 329-8607   Toll Free: (877) 536-6219
E-Fax: (815) 333-1937
E-Mail: support@mirage-net.com

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(Evenings/Weekends By Appointment)
Providing Your Professional Internet Presence
You've built a professional business and we'll build your professional Internet Presence with custom
website development & graphic design, domain registration & hosting, database and e-commerce solutions. 		 
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Requesting a FREE Personalized Price Quote is Easy and Fast !

Mirage-Net sites are as unique as our clients... We do not use impersonal templates when designing YOUR site! We rely on getting to know you and your unique preferences when creating a CUSTOM site that meets YOUR needs.

We need to work together... with you... as a TEAM. After all...
If YOU don't take your website serious, why should anyone else?

To help us provide you with an accurate price quote and develop a FREE temporary page outlining our design ideas with your likes/dislikes in mind... we need your input. Just fill in the form below answering all questions that apply to you then click on "Submit Request". (Fields In RED Are Required)

Free Quote Request Form
CONTACT INFORMATION
Contact Name:
Contact E-Mail:
Name of Business:
Type of Business:
Title/Position:
Street Address:
City:
State or Region:
Zip/Postal Code:
Country:
Home Phone:
Work Phone:
FAX Number:
Best Time To Call:

SERVICES TO QUOTE

Please Answer All Questions That Apply

Type Of Website:
Business   Commercial   Personal   Not Required

Website Work Desired:
Develop New Site   Re-Work Existing   N/A

Approx.No.Of Pages:  

Self-Replicating Site:
n/a   Yes   No

Type Of Ad Banner:
Not Required   Animated   Non-Animated

Custom Logo:
Not Required   Need Designed   Will Provide

Custom Graphics: (Buttons, Icons, etc.) :
Not Required   Need Designed   Will Provide

Are MouseOver Effects Desired?
n/a   Yes   No   Undecided

No. Of Products/Services Sold From Site:  
Check All Additional Desired Features That Apply:
Guestbook
Photo Gallery
Live Help
Chat Room 		    Message Board
Shopping Cart
Opt-In Newsletter
Event Calendar

Do You Have An Existing Site?
Yes   No

(If YES, What Is The URL?)

ADDITIONAL HELPFUL INFORMATION

The following will assist us in our efforts to
customize our design work for you personally.

What Is The Main Purpose Of Your Website?

Describe The Type Of Viewers You Intend To Reach

Provide A Short Company Description or History

Provide A Description of Products and/or Services

Have You seen other sites that appeal to you?
If so... please list up to 3 of those sites below.

Any Additional Comments & Considerations
( Maybe tell us a bit about yourself... favorite colors, etc. )

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