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Service Initial Contact Form
Name or Pseudonym
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Pronouns
*
How would you prefer to be contacted?
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Which services are you interested in?
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Website Health Check
Automation & Scripting
Website Refactor / Rebuild
Website Development (New Build)
Digital Safety Consult
Unique Project
What kind of support are you looking for?
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How urgently is this work needing to be completed?
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Let's find a service tier that fits your budget!
Which of the following best describes your current budget?
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A
No Budget
B
Limited Budget
C
Funded Budget
Are any of the following circumstances true for your situation? Select all that apply.
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I am low-income / on a fixed income
I work in mutual aid
I am in crisis
Website Health Check? Let's find a Service Tier that fits your budget!
Which of the following best describes your current budget?
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A
No Budget
B
Limited Budget
C
Funded Budget
Is there anything you would like to ask, or anything I should know before reaching out?
Consent:
*
I understand that this intake form does not guarantee availability or services. I understand that I will be contacted via the method I chose above if there is a fit and availability to complete the work within the time frame indicated.