Please fill out the form completely before you press submit.

Please take time and fill out each of the areas of our form completely. This information will be used in the design of your website and any missing information will not be added to your website or designed/coded at our best discretion. All files that need to be sent with your website design/content can be emailed to this address: sales@myinternetpartner.com

Please Note: We cannot begin the site design or layout for your website without the page titles and color choices. All content should be sent using the form or emailed to the address above as soon as possible. No content will be placed on the website until ALL content is collected.


:: Company Information ::

This information will be used in the setup of your website as well as the contact information associated with your project. Please make sure that all information is accurate.


* Company Name:
* Contact Name:
* Your Website URL:
* Your Current Email Address:
* Confirm Current Email Address:
* Phone Number:

:: Current Website ::

This information is in regards to a current website that you may have online. We need the following information to be able to access the domain, hosting and or files related to your current website. If you do not have this information available, please obtain it. Your current domain cannot be pointed to our servers without it.

If you do not have a current website please skip the following section.


* Domain Registrar:
* Domain Login: (Case Sensitive)
* Domain Password: (Case Sensitive)
* Host Company:
* Host Login: (Case Sensitive)
* Host Password: (Case Sensitive)

:: Website Goal ::

Please help us develop a website that works for you. Give us some information on the purpose this website should serve for your company. This will give us a target for functionality as well as provide areas that we need to pay special attention to. We do understand that most websites could fit into a number of these target areas, we ask this only to help focus the website on your specific target.


* Website Goal:


:: Database Options ::

Please specify which, if any, optional database functionality your website requires. Please note that some packages include database functionality and some do not. Adding database functionality to your website may increase the development time for your website. Please check with your sales representative about the price of including database functionality to your website as this may not be included in the plan you have signed up for.


* Mass Email Database:

* Product Database:

* Photo Database:

* Shopping Cart:

* Property Database:

* Other Database:

* If Other: Please Describe:


:: Layout Options ::

This information will be used in the creation of the layout of your project. Any specific notes as to the design should be described in detail below. This will give our design team an idea of your likes and dislikes and helps in creating a project that reflects the design of your business.


* 3 Colors (light,medium,dark):

* Websites I Like #1:

* Websites I Like #2:

* Websites I Like #3:

* Do You Have A Logo:

Yes :       No :  

* Do You Require Flash:

Yes :       No :  

* Do You Require Video:

Yes :       No :  

* Do You Require Music Playing:

Yes :       No :  

* Logo Notes:

* Design Notes:

* Layout Notes: Please Describe Everything You Like About The Websites You Listed And Any Other Design, Layout Or Function Requirements.


:: Search Engine Optimization ::

The information below will help us in submitting your information for search engine submission. We do offer a service to help in placing your website higher on search engine results.


* Interested in SEO:

Yes :       No :  

* Keywords:


:: Credit Card Information ::

Please verify that all information submitted below is accurate. This information will be used to pay for the setup fee (if any) and the monthly payments. Please make sure to read and accept the MyInternetPartner.com terms and conditions.


* Name On Card:

* Credit Card Number:

* Experation Date:

* Security Code:

* Credit Card Type:

* Plan Type:

* Contract Submitted:

Yes :       No :  

* I have read and agreed to the MyInternetPartner terms and conditions:

Yes :       No :  

( You must fill in the fields marked with a * )
( These items may affect the pricing or your setup or monthly fee * )

Secured!       Visa/Mastercard