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First Name

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Last Name

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Company Name

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Telephone

(Please, provide a phone number in format, where X is a digit)

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How do you "prefer" that we contact you:

(By Phone or Email)

Email Address

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Rep / Firm Name:

Your Current Website:

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Tell us about your business :

1. What goals you would like to accomplish with your website:

2. Type of Services Needed:

(check as many as you need)

Informational Website

eCommerce Website (online store)

Customized Blog

Logo/Branding

Copywriting Services (Content Writing)

3. Please provide details for the services selected above:

4. If you need a website, how large of a site do you need?

5 Page Starter Site

6-10 Pages

10-20 Pages

More Than 20 Pages

5. If need an eCommerce...how do you plan to accept credit cards:

I already accept credit cards in my store and plan to use that merchant account.

I want to use PayPal.

I do not want to use PayPal and would like other recommendations.

I need help in this area.

6. IF YOU SELECTED eCommerce...will you need help with your product images after we have finished building your site?

No, I'm proficient in an image editing software

Definitely, I'm too busy to do this for myself

What is image editing software?

7. Please describe any additional functions your website needs to have:

8. Project Target Date:

Please pick a date at least 2 weeks into the future.

9. How much have you budgeted for this project :

$

10. Company Logo

I have a logo and can send the files needed.

I need this and I've checked logo above.

I don't really have or want a logo.

11. Please give us a few examples of websites that you like the style of so we can have a feel of your desired results.

12. What do you like about these websites:

13. I understand that this quote is good for the next 7 days only!

I agree

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