| How Did You Hear About Us: |
| How Did You Hear About Us: |
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If by Referral, Please Specify: |
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| Contact Info: |
Your Name: |
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Company Name: |
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Address: |
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City: |
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| State: |
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| ZIP: |
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Phone: |
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| Fax: |
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E-mail address: |
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| Website History: |
| Do you have a domain name? |
Yes
no |
| If yes, what is your domain name? |
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| If no, what are some of the domain name ideas you have (i.e. MyDomainName.com) ? |
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| Do you have a website? |
Yes
no |
If yes, where is your site hosted?
(include web address) |
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If you already have a website,
do you want a complete overhaul
or just minor additions or changes? |
Overhaul
Just changes or additions |
| Website Summary: |
| How would you classify your website? |
Selling Products Online
Informational
Both |
| What is the main purpose of your website? What are your short-term and long-term goals for the website? |
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| What is your intended launch date? |
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What is your Budget? |
| What is your budget? |
$1000 - $1500
$1500 - $2000
$2000 - $3000
$3000- $4000
$4000- $5000
over $5000 |
Who's your target audience? |
| In order to create a good website it's a smart idea to design it specifically for your target audience. Answer these questions so we can define who your target audience is. |
What is the age group of your target audience?
Check all that apply |
14 and under
15-24
25-34
35-44
45-54
55-64
over 65
all of the above |
| Gender: |
Male
Female
Both |
| Selling products? |
| Do you need a shopping cart? |
Yes
no |
| Do you already have a shopping cart? |
Yes
no |
| If you already have a shopping cart, will you need modifications? |
Yes
no |
| Approximately h ow many products are you/will you be selling? |
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| If you NEED a shopping cart answer these questions if you can: |
| Do you already have a Merchant Account? |
Yes
no
don't know |
| If Yes with whom? |
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Do you wish to have a gateway?
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Yes
no
don't know |
| How would you like to accept payment? Please select all that apply: |
Visa
Mastercard
Amex
Discover
Paypal
Check
Money Order
COD |
| Additional Comments: |
Please enter any additional comments in the text box below. |
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