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Full Name
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Company
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Address 2
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Phone 1
Phone 2
Email
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Website 1
Website 2
Website 3
Website 4
Website 5
Internet Experience
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1 to 2 years
3 to 5 years
6 to 8 years
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Programming Skills
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ASP
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PHP
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MS SQL/MySql
Visual Basic
XML
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Position Desired
Contractor
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Sales
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Please describe any additional skills or talents you feel we should consider.