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jerryschraderconsulting.com
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March 24, 2026
Website Request Form
Your Name
*
Email Address
Business Phone
Business Name
Neighborhood / City
Business Type
Select your business type…
Landscaping
Home Services
Real Estate Agent
Salon / Spa
Restaurant / Food
Retail
Professional Services
Other
Brief Description of What You Do
*
Keep it brief – 2 to 3 sentences is perfect.
How Long Have You Been in Business?
Select…
Under 1 year
1-3 years
3-10 years
10+ years
Do You Currently Have a Website?
Yes
No
Yes, but it’s outdated
Current Website URL (if you have one)
Optional – skip if you don’t have one yet.
What's the Main Goal of Your Website? (check all that apply)
Get more customers
Show my work / portfolio
Online booking
Sell products online
Just need a web presence
Other
A Website You Love the Look Of
Optional – paste a URL if there’s a site or style you’re drawn to.
Anything Specific You Want (or Don't Want) on Your Site?
Optional – but the more you share, the better.
Portfolio Agreement
*
I understand this is a portfolio project and agree to have my completed website featured in Jerry’s portfolio.
Review Agreement
*
I agree to write an honest review about the experience and website after the project is complete.
How Did You Hear About This?
Select…
NextDoor
Word of mouth
Other
Submit My Application