Preferred contact method:
Email
Phone
No Preference
Name:
Street or PO Box:
City, State, ZIP Code:
Email
address:
Phone #:
Area of interest:
(Check all that apply)
New website design
Update existing website
Continuing monthly maintenance w/design or redesign
Email newsletter/Promotional brochure/Flyer
Company name:
Purpose of website:
Target audience:
Type of business:
Years in business:
Company logo:
Have a Logo
Need a Logo
Need a Redesign
Existing promotional material:
(Check all that apply)
Newsletter/Brochure/Pamphlet/Flyer
Artwork
Audio Ad
Video Ad
Photos
Forms for clients to view/print
Website ideas:
If you desire a redesign, briefly explain what you don't
like about your current site and/or what you wish to change:
Websites you like that might be used as a guide for your site:
(Colors, format, overall feel, etc)
Website layout:
Give a brief overview of the pages you wish to include in the website:
(Ex: Home Page, Company Profile, Products,
Order Form, Customer Service, Contact Us)
Total # of pages needed:
Not Sure
1 - 2 Pages
3 - 5 Pages
6 - 10 Pages
11 - 20 Pages
Over 20 Pages
Frequency of maintenance needed:
Not Needed
Not Sure
Daily
Weekly
Monthly
Less than Monthly
Domain name registration needed?
Yes
No
Not Sure
Yes
No
Not Sure
If yes, do you need assistance with registration?
Desired domain name:
Web hosting needed?
Yes
No
Not Sure
Timeline for website completion:
3 to 4 Weeks
4 to 8 Weeks
Over 8 Weeks
Budget:
Not Sure
Under $500
$500 - $1,000
$1,000 - $2,000
Over $2,000
How did you hear about us?
Additional features desired:
(Check all that apply)
Files for download
Forms/Catalogs for view/print
Blog/Message Board
Password protected area
Shopping Cart
Other -- Please explain:
E-Commerce:
No
Yes
Not Sure
Do you wish to sell services/goods on your site?
If yes, how many items?
Additional comments:
* Verify that you wish to send this form:
(Answer must be yes to send)
No
Yes