*Name:

Address:

City:

State:

Zip Code:

*Phone: (with area code and ext.)

Fax:

*E-mail:

I am interested in an estimate for: (select all that apply) A personal web site
A business web site
A redesigned web site
print layout
printing
seo
illustration

My current URL is:

I anticipate I will need a total of pages in my Web site.

And/Or: Brochure
Collateral Material
Logo & Stationery Package
Original Illustration
Other:
Specify

*Company or Organization Name:

Your position:

Size of Company
(quantity of employees) Select 1 - 5 5 - 10 10 - 25 25 - 100 100 - 500 500 - 1000 1000 +

*Budget allocated for this entire project : $
(Visa & Mastercard are accepted)

Purpose of Website:

Target Audience
Who will use your site? Who do you want to visit your site?:

I already have
Domain Name:
Yes No Don't Know

Internet Service Provider (Host): Yes No Don't Know

I will provide: Logo
Company Photos
Company brochure or other collateral materials
All text - written and edited
OR
Reference text - needs professional copywriting

Specifications Required:

Do you plan to sell products or services electronically through this web site?:
Yes No Don't Know

If yes, will you be needing the following services?: Secure server for processing transactions
Merchant account through your bank (or alternative)
Online purchases by credit card, fax and postal mail
Shopping cart software
A system that integrates easily with new or existing accounting software

Will you want Search Engine Registration, Optimization?: Yes No Don't Know

Will you be needing monthly site maintenance for regular updates?: Yes No Don't Know
If yes, please explain

Comments:

Graphic: