|
Name |
* |
|
Address |
*
|
|
City |
*
|
|
State |
* |
|
ZIP |
*
|
|
Email |
* |
|
Telephone |
*
|
|
Name of sales rep. or referrer
(If
applicable) |
Name, or
Company |
|
I am interested in |
* |
| I need a logo |
Yes
No |
|
Project Time frame |
|
|
Project Budget |
to |
|
What is the purpose of this web
site? |
Personal
Business Other
Explain:
|
| Do you currently have a web
site? |
Web Site: Yes No
If so, what is your current
URL: |
| List some site that are similar in
design to what your looking
for. |
|
| Estimate how many pages your site will
contain. |
|
| Please list the menu items for your
web site. |
-
Home
Page
-
About
Us
-
General
Info
-
Contact
Us
-
Photo/Products
Gallery
-
Other
-
Testimonies
-
Services
-
Site
Map
-
Personal
Bio
-
Payment
Page
-
Membership
Sign Up Page
|
| Tell us about your project (Please
be detailed). |
|
|
Do you want to accept payments for products
on your web site? |
Payments: Yes No
If so, who will you be accepting
payments with?
PayPal
Merchant Account Other
Undecided
|
|
Do you need a domain
name? |
Yes No
|
|
Do you need web
hosting? |
Yes No |
|
Do you need site
maintenance? |
Yes No
|
