Custom Build Design Form

Welcome to the Custom Build Design Form, this will help us get started with the design process, please fill out the information to the best of your ability. 

We would like to setup a consultation to learn more about your project request. Below you’ll be prompted to set a date and time.

We look forward to hearing from you!

Custom Design Form

Contact Information

First Name *

Last Name *

Title

Email Address *

Mobile Number

Daytime Number

Alternate Contact Details

First Name

Last Name

Email Address

Contact Number

Treasurer or Accountant Contact Information

First Name of Treasurer or Accountant *

Last Name *

Email Address *

Contact Number

Organization Information

Organization Name *

Street Address *

City *

State *

Zip *

Organization Phone *

Fax

We Wish To Be Billed *

Monthly

Quarterly

Yearly

Domain Name

Current Domain Name

If You Do Not Have a Current Domain Name List Your Preferences

Second Domain Choice

Website Design Specs

Your Preferred Layout (Click the links for examples) *

Old School Design - Progressfire.com

Business Professional - Piermontfd13.com

FireCompanies Hybrid - New design that allows for your banner ads

FireCompanies Simple Design - Departments that want a web presence without updating a lot

FireCompanies Clean Design - City of Lambertville Fire Department District #1

We like the look of this site:We like the look of this site:

Color 1 We Would like Used *

Color 2 We Would like Used *

Color 3 We Would like Used *

Banner Design Specs

How Would You Like Your Organization's Name Appear? *

Organization Motto

Additional Text

Check The Box!