Basic Information
Name* :
Title:
Company* :
City:
State/Province:
Select your State or Province
STATES
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
PROVINCES
Alberta
British Columbia
Manitoba
New Brunswick
New Foundland
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Country (if outside USA):
Email Address* :
Phone:
Domain Registration & Hosting
Do you need a domain name registered?
Yes
No
Current Domain Name (URL):
example: http://www.your-domain-name.com
Do you want hosting set up?
Yes
No
Background & Objectives
What does your business do?
Size of your company:
Small
Medium
Large
What are your goals for the site?
Sell products/services online.
How many products do you have:
Marketing tool to get new customers/clients
Information resource for current customers
Provide customer service.
What type of service?
Services Required:
Design new site. Number of pages?
Re-design current site
Promote and market site
Additional Services
Do you accept credit cards?
Yes
No
We would like to accept credit cards
What features (functionality) or services
do you want your site to have?
Shopping Cart.
Approximate products/services:
Site that uses information from our database.
What type of
database do you have?
Opt-in Email newsletter or ezine
Collect surfer information for data gathering
Site that surfer can search internally
Surfers can download software or other files
What promotion services would you like?
Optimize pages so good indexing by engines
Submit site to engines and directories
Improve link popularity
Recommend paid submission/pay-per-click programs
What other marketing services would you like?
Web Site Look & Feel
What other sites do you like that are similar to the type
of design you want?
What do you like about them?
What do you NOT want on your site?
What graphics, photos and other art do you have?
What graphics, photos and other art do you need designed?
Web Site Content & Scope
Will you write the text or will we write it?
I Will Write It
You Write It
Other information:
Additional Information
What is your design budget?
$500 to $1000
$1000 to $3000
$3000 to $5000
$5000 to $10,000
$10,000 to $20,000
$20,000 to $50,000
Greater than $50,000
Or Specify:
What is your marketing budget?
$500 to $1000
$1000 to $3000
$3000 to $5000
$5000 to $10,000
$10,000 to $20,000
$20,000 to $50,000
Greater than $50,000
Or Specify:
Do you have a deadline when the site must be completed?
If yes, when:
Questions or other information we may need:
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