Telephone Number
Preferred Method of Contact
Telephone
E-Mail
Either
New web site design or redesign of an existing web site?
New
Re-Design Existing Site
If this is a redesign, what is the current URL?
Do you have a Domain Name (www.mycompany.com) registered?
Yes
No
Will you require hosting for your web site?
Yes No
Type of Web Site Needed
Small Business
Non-Profit Organization
Personal or Family
What will be or what is the purpose of your web site?
Advertise my business.
Sell products and/or services.
To provide resource(s) or information.
List one or two web sites similar to your business that you like.
How many pages do you anticipate your site having?
How will you be providing the text for your web site?
I will provide all of the text with no editing required.
I will provide all of the text, but it will require editing.
I will provide most of the text, but it will require editing.
I will need you to develop and edit my text.
Can you supply text and images in digital format?
Yes
No
Do you have any graphics (photos, logo, artwork, etc) that may be used for your web site?
Yes
No
Do you need any graphics scanned?
Yes
No
Will you require web site updates and maintenance?
Yes
No
What is your anticipated budget for your web site?
less than $500
$500 - $1,000
$1,000 - $2,500
$2,500 - $5,000
$5,000 +
Please list additional features, requests or comments you may have about your web site.