Requestor Information

First Name *

Last Name *

Email *

Phone *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Business Information

Business Name *

Business Phone *

Business Email *

Business Industry *

Business Colors (HEX Colors if known) *

Slogan or Tagline *

Business Hours *

Design Requirements

Sample Websites You Like: *

What Products or Services Do Your Offer? *

Tell Us About Your Business *

Describe your ideal customers (age range, race, religion, location, income) *

What makes your business different from your competitors? *

Social Media (links) *

What payment methods do you accepts? *

Terms and Acknowledgements

I confirm that the information I have provided is accurate and complete to the best of my knowledge. I understand that Rexelion LLC will rely on this information to provide the requested services. *

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I acknowledge that payment in full is required before my website goes live. I understand that the website launch date and time will be coordinated and scheduled based on availability between myself and a Rexelion LLC team member. *

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I understand that Rexelion LLC provides Tier 1 support at no cost for up to six (6) months after my website launch. I acknowledge that any support requested after this period will require enrollment in a paid support plan or an ad hoc support agreement. *

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I acknowledge that Rexelion LLC will make reasonable efforts to stay in contact with me throughout the website design process. If I fail to respond or cannot be reached for thirty (30) consecutive days after requesting services, my account will be considered inactive. I understand that failure to respond within this timeframe will result in forfeiture of any refund, and no refund will be issued. *

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I understand that any information submitted will be handled confidentially and used solely to evaluate my request and provide relevant services, in accordance with Rexelion LLC’s privacy practices. *

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Please check your email for the payment link. Once payment is received, work on this project will begin the following business day. Please sign below to acknowledge you understand. *

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