| Enter Today's Date: |
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| Business Name: |
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| Business Address: |
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| City, State and Zip: |
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| Primary Contact Number's |
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| Email Address |
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| Domain Name Required (www.???.com) |
Yes
No |
| If above answer is Yes, Provide up
to three desired names.
If No, Enter your website name.
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www.
(.com, .net, .org, .edu, .biz )
www.
www. |
| Do you have a Web Host Provider? |
Yes
No |
| Will you design/build your own Web
Site? |
Yes
No |
| Do you need a Logo Designed? |
Yes
No |
| Do you have graphic files/photos
for your site? |
Yes No
If Yes, how many? |
| Do you require any animated
graphics? |
Yes
No If Yes,
how many? |
| Do you intend to sell products on
your Website? (e-commerce) |
Yes
No |
| Do you require audio/video web
streaming? |
Yes
No |
| Do you require a database/search
ability? |
Yes
No |
| Do you currently provide any of the
following information to your customers or prospects as part of doing
business? |
Forms:
Applications:
Brochures:
White Papers:
Other: |
| Select Web Page categories desired
for your site. |
Table of Contents:
About Us page:
Our Products page
Our Service page:
Our Customers page:
Other (describe):
Other (describe):
Other (describe):
Other (describe): |
| Select Desired Web Solutions
Package |
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Comments or special requirements:
Please give details on what you want your website to do. Some
questions to think are target audience, content, layout or design,
background colors, pictures or illustrations, question and answer,
printable forms for customers, etc... |
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