Company Name:
First Name *
Last Name *
Year Business Established:
Mailing Address *
City *
State/Province *
Postal/Zip Code *
Country *
Select... United States Canada
E-Mail Address *
Do you currently have a website?
Yes No
If yes, please input provide the URL:
Briefly describe the service or product your company or organization provides:
What are your budget requirements or restrictions?
Who will be the primary decision-maker(s) regarding the website's design?
Select... Me alone Website Committee Business Owner Executive Board
If other than you alone, please provide the full name(s) of all who will be involved:
List company or companies you consider to be your direct competitors:
Please list the URL(s) to your competitor(s)' website(s):
Please describe what you like or dislike about their website(s):
What products and/or services distinguish you from your competitor(s):
Identify 4 Websites (URLs) that reflect the style,
color and feel you would like for your Website:
Website #1:
Website #2:
Website #3:
Website #4:
Describe what you like (or dislike) about the above websites:
Describe the colors, style, and feel you would like for your website:
Describe your target market/main users (EX: professional women age 24 to 45, etc.):
What is the likeliest way your
target audience accesses the Internet?
Dial-up:
DSL:
Cable:
Wireless:
When someone remarks about your company, what would you like them to say?
We need our website to...
(Check all that apply)
feature information about products/services:
advertise and/or sell products/services:
reflect our vision/purpose:
be better than our competitors':
create an Internet presence:
Other:
Style - Select the most appropriate
statement(s):
Our site should be easy to self-maintain.
Our site should have a formal style.
Our site should be warm and casual.
Our site should feature Flash, video, & other animation.
Our site should load quickly - less graphics.
Other:
Expected number of pages needed:
Will your site have forms or newsletter subscriptions?
Yes No
If Yes, please describe:
Describe the graphics you can/will provide:
Describe the graphics you would like us to provide/design:
Will you need to purchase stock photograpy?
Yes No Uncertain
Will your site offer FREE downloads for site users?
Yes No Undecided
Will your site need a shopping cart?
Yes No
Will your site need a 'Members Only' area?
Yes No
Will your site require the use of databases?
Yes No
Will your site employ Flash, video, and/or audio?
Yes No
If you answered 'Yes' to any of the above, please describe:
Please provide additional information you think will prove helpful:
Please type the characters as shown: