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Please fill out the following application form in order to receive an offer without engagement from Jewelcase Fullservice Internet Design. The data will be sent to us through email of which you will receive a carbon copy.

Description of tasks to do
Website present at the moment? no / yes, domain
What would you like to change?
Number of website pages
Functionalities
email form
guestbook
shop
content management
database parts
Further remarks
Your name and address details
Full name Mr / Mrs
Company
Address
Town/City & Postcode 
Telephone number* 
Fax number
Mobile number
Email address* 
I would like to
receive the offer by		 email / fax / telephone / mail

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