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Your contact Information

Name:
Address:
City, State, Zip Code:
Home Phone Number:
Work/Mobile Phone Number:
Email:

Background, Objectives, Domain Name registration & Hosting

What does your business do?

Size of your Company	Small Medium Large
What are the goals for the site?	Information resource for current customers Marketing tool to get new customers Provide customer service; type of service?
Design Services required:	Design new site; number of pages if known Re-design current site
Do you need a domain name registered?	Yes No
Current Domain Name (URL)	ex. http://www.yourdomainname.com
Do you want hosting setup for you?	Yes No

Additional Design Services Required

Do you accept credit cards?	Yes No We would like to accept credit cards
What features or functionality do you want your website to have?	Shopping Cart/E-Commerce Bulletin Board Contact Form Guest Book Other; specify

Web Site Look & Feel

What other sites do you like that are similar to the type of design that you want?
What is it that you like about them?
List any graphics, photos, logo or other art that you have.
Do you have colors or corporate color scheme that you want to use? If you do, please list them.

Additional Information

Do you have a deadline when the site must be completed?	Yes No If yes, when?

Other Information

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