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Contact Name:
*
First
Last
Company Name:
*
Address:
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone:
*
Fax:
Email:
*
Website (if redesign):
Please select one that best describes you:
*
Window shopping: Not yet sure I need a website
Evaluating feasibility: Need a website but I'm not sure what it takes
Actively looking: Ready to hire someone and begin the process
Need a website ASAP: Must get started immediately
Check any that you want or need:
*
Register a domain name (yourcompany.com)
Host your website
Create graphics for website
User registration (password security)
Information collection forms
Site traffic statistics
Message boards
Personalization of user experience
Audio/Video
Multi-lingual website
Email addresses (name@yourcompany.com)
Advertising banners
Online ordering
Real-time credit card transactions
Secure pages
Database integration
Remote administration (self-maintenance)
Please select the "look-and-feel" for the website:
*
Simple
Graphic-intensive
Flashy, jazzy, edgy
Approximate number of pages to be created:
*
< 5
6 - 10
11 - 20
21 - 30
31 - 40
41 - 50
50+
We will maintain your website:
*
Will be done in-house by company staff
Will require web design company to maintain site
Not sure
Goals for website:
*
Sales
Marketing
Advertising
Communication
Access to information
Other
Desired time frame:
*
< 2 weeks
2 - 4 weeks
4 - 6 weeks
6 - 8 weeks
8 - 10 weeks
10 - 12 weeks
Not sure
Budget for the project:
*
< $1,000
$1,000 - $2,000
$2,000 - $5,000
$5,000 - $10,000
$10,000 - $20,000
> $20,000
Not sure
Where heard about us:
*
Search engine (Google, etc.)
Word of mouth
Regional Chamber
Expo/Showcase
Advertising
Another website
Describe industry:
List competitors:
Desired addresses: (yourbusiness.com)
What are your products or services:
What type of visitors would you like to draw to the site:
Describe any preparations that have already been made for the web site:
Describe any specific logos, artwork, fonts, etc. that you would like used:
List any desired characteristics for the web site (color, user interface, page layout, navigation, size of site, etc.):
List main areas of the website (services, about us, links, etc.):
How much site maintenance will be required and how often (when will page content change and what will change):
Describe the long-term plans for the web site:
Additional comments or questions:
Send estiamte via:
*
E-mail
Fax
Phone call
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