| Name: |
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| Company: |
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| Email Address: |
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| Phone: |
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| Address: |
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| City, State, Zip: |
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| Country: |
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What are the main goals of the Web Site: (check all that apply)
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| Sell products by accepting online payments |
| Sell services by selecting online payments |
| Just display products, services, or portfolios on the site |
| Provide information about your business |
| Allow customers to contact you |
| A church or ministry site |
| A musician's site geared for selling music |
| A musician's site geared for displaying band information and events |
| Contact customers through a mailing list or newsletter |
| Allow visitors to be in chat groups |
| Allow visitors to download files like music, pictures, videos, software, etc. |
| Primarily an information related site |
| Other (please describe) |
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Which of the following features do you require:
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| Contact form |
| Updatable products and services |
| Search functionality - so visitors can search for products, etc. |
| Login area where visitors enter a username and password to allow access to parts of your site |
| Discussion forums |
| Blog/Guestbook so visitors can leave messages |
| Multimedia like streaming video and audio |
| Display news feeds |
| Create and display articles |
| Online calendars |
| Other (please describe) |
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Which services do you need:
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| A domain name |
| Web hosting |
| A secure payment system |
| Ongoing maintenance of the web site |
| Other (please describe) |
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What other items do you need:
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| Graphic design |
| Logo design |
| Business card design |
| Picture enhancement (photo editing, cropping, resizing, thumbnails, etc.) |
| Music creation |
| Video creation |
| Panoramic pictures |
| Other (please describe) |
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Describe yourself/company and the desired design and appearance of your site:
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| What does your business do? |
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| What products and services do you sell? |
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| Do you have an idea of how your site should look? |
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| Can you provide any drawings or plans? |
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| What color scheme do you want? |
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| Can you provide the written content, images, music files, video files or other files? |
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| Are there any sites on the web that are similar to yours: (please list web addresses) |
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Order