Web Site Questionnaire

Contact Name: *

Company Name:   *

Contact Email: *

Phone Number: *

Fax Number:

Address 1: *

Address 2:

City: * State: Select State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 * Zip: *

How did you hear of our company? *** Select One *** Yellow Pages Advertisement Internet Referral Other

If referral, whom?:

Services Requested: *

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Web Site Design
Redesign Web Site
Custom Graphics
Logo / Banner Design
Shopping Cart (Please specify amount of products)
E-Mail Marketing
Web Hosting
Search Engine Positioning
Flash Animation / Presentation / Intro
Merchant Account
Database

Explanation of Project: *


If site redesign, what are your likes and dislikes about your current web site?

Budget Range: *** Select One *** $250-$500 $501-$1000 $1001-$1500 $1501-$2500 $2501-$5000 %5001-$10000 $10001+

Site Information: *

Site Type: *** Select One *** Small Business Corporation E-Commerce Online Catalog Personal Non-Profit Religous Number of Pages (approx.):
Number of Photos / Graphics (approx.):
Color Preferences: Typeface:

Additional Pages:

Contact Us Form
Search Function
Custom Scripts (JAVA, CGI, PHP)
Custom Software Development

 

Domain / ISP Information:

Do you have a web site address already registered? Yes No

Domain Name: WWW. * * Select One * * .com .net .org .biz .info
If yes, what company are you registered with?:

If you do not have a domain name registered, please list 3 choices:

Do you require hosting for your domain?: Yes No

Web Site Details: *

Tell us about your company (business type):

Do any of your competitors have web sites? (If so, please list 4 of their web site):

Who is your target audience for your web site?:

Please describe the purpose of the web site and provide any other information that you feel will be helpfull:

Which of our packages do you think would best fit your needs?
*** Select One *** Standard Package Advanced Package Custom Web Site Package

How soon do you need to start the project? *** Select One *** Soon Within 2 weeks Within 2-4 weeks Within 4-6 weeks 6+ weeks

Please hit the "SUBMIT" button only once!

You will then be returned to the home page. Thank you ......

* Required Fields