| General information |
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Your Full Name
(*Required fields) |
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Postal Address: |
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Telephone Number: |
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Other Telephone Number: |
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Fax: |
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Email: |
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| Business Details |
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Business Name: |
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Type of Industry: |
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Type of Business: |
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Type of Product/Service: |
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Who are your Customers: |
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| Design Requirements |
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Do you require a 'New' web site or 'Redesign' of an existing site: |
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If Redesign, what is your current web address: |
http://www.
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If New Design, what would you like for a web address: |
http://www.
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How many pages you require: |
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How many pictures do you you require: |
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How many external Links would you require: |
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Do you require a Company Logo: |
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Give us a list of your competitors web sites or sites you want to look like here.(optional) |
http://www.
http://www.
http://www.
http://www.
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| To the best of your knowledge do you require any of the following: |
Web Graphics |
Flash |
Animation |
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Sound |
Scripts |
Database Programming |
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Web Forms |
Guest Book |
On-line Marketing |
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Forum |
Shopping Cart |
Credit Card Transactions |
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Web Hosting |
Site Maintenance |
Domain Name / Web Address |
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Do you require any other services: |
Print Work (such as stationery, brochures, flyers, etc.)
CD ROM Business Cards
Business Cards |
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What is your budget: |
If you choose other or have a set price in mind, please indicate the amount here
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What is your time frame: |
If you choose other or have a set date/time frame in mind, please indicate the date here
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Comments:
Please provide any other information you think might be useful. |
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