Basic Information

First & Last Name:

Company Name:

Type of Business:

Address:

City:

State/Province:

Country:

Zip/Postal code:

Email Address:

Phone Number (with area code):

FAX Number (with area code):

I am ordering the following hosting plan:

Free Website & Hosting
Corporate Website
E-Comm. Shopping Cart

For A New Website To Be Designed
(Skip this section for free website or when transferring an existing website.)

Two example websites that are similar to what I want:

I expect that my website will be:

A "starter" website for my company to establish a presence on the Internet (1 - 5 webpages).

A larger website that describes my company's products and services with relatively static content (6 - 10 webpages).

A relatively large website that fully catalogs and describes my company's products and services and/or one that may include dynamic content (11 - 20 webpages).

A large website with a database and/or an e-commerce/shopping cart capability to display my products and allow customers to place orders online.

I would also like to incorporate the following into my website (feel free to describe any ideas or special requirements you may have):

  

I have (or will have) the following type of material available for a website designer to work with:

Text information that describes my company's product and services.
In electronic format  In hardcopy format

Company logo, letterhead or artwork suitable for scanning.

Photographs that I would like to have scanned and included.

A rough sketch of how I would like my webpages to look.

Please use this area for a list of up to twenty keywords you would like associated with your site. These may be single words or phrases:

Optional Add-Ons
(Skip this section for free website.)

I am interested in the following:

Auction
Forum
Shopping Cart
Database

For An Existing Website (Hosting Transfer)
(Skip this section for free website.)

The URL of my website is:

I will want to manage the content updates to my website:

Yes   No   Maybe  

Questions and Comments

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