ProxMedia Client Intake

01 — YOUR INFO

Your Name *

Email Address *

Phone Number *

02 — YOUR BUSINESS

Business Name *

Type of Business *

City / Location *

Services You Offer *

03 — YOUR PACKAGE

Package Purchased *

Domain Name (if you have one)

Existing Website URL (if any)

04 — DESIGN & GOALS

Preferred Style / Vibe

Brand Colors (if any)

Main Goal for the Website *

Sites You Like (optional)

Anything Else We Should Know

We review every intake within 1 business day and reach out to confirm your build start date.

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You're in.

We've received your intake. Build starts within 24 hours. We'll reach out to confirm details and share a preview link when it's ready.