Your Name:

Company Name:

Phone Number:

Address:

City:

State:

Zip:

Country:

Your Email:

Business Description:

Enter a description of your business or organization.

Project Description:

Enter a description of your proposed Web site or Web project.

Project Objectives:

Enter a list of goals related to the Web site or project.

Web Content:

Enter a brief description of any existing content (paper, brochures, documents, databases, etc.)

Target Audience:

Your desired target audience for the Web site.

Time frame (select one):

Now As soon as possible This month This quarter This year No hurry Not sure yet

Business System Interfaces (select any):

None Database Not Sure Other

Will the project be part of an intranet?

Yes: No:

Will site visitors need to login?

All: None: Members Only:

Do you plan to advertise your site?

Yes: No:

Will your site content change frequently?

Yes: No:

Do you have a logo?

Yes: No:

Do you have a color scheme?

Yes: No:

If yes, please list colors:

Do you already have graphics?

Yes: No: Some:

Do you have a domain name?

Yes: No:

If no, please include desired name:

If you already have one or more Web sites please list one or two URLs which we may visit.

URL:

URL:

Will you be selling one or more products through your Web site?

Yes: No:

How many different products do you sell?

None 1-10 11-100 more than 100

Do you have a merchant credit account (do you accept credit cards)?

Yes: No:

Would you like more information about our Web site packages?

Please select from the following list: -------------------------------- Single Page Web site Starter Web site Small Business Web site Online Store Web site Web site Maintenance Plan

Would you like to receive a free written estimate?

Yes: No:

Additional Information: