Name:	*
Company/organization:
Street Address:	*
City:	*
State:	*
Zip:	*
Phone:
Fax:
E-mail:	*
Current Web Site:
The primary purpose of this Web Site will be (check all that apply):
Informational: Providing your visitors sales and contact information; E-Commerce: Offering online shopping, service payment options, or order placement; Organizational: This Web Site is for a government, religious, or other non-commercial entity.
Of the following, my primary concern for this WebSite is:
Style/Appearance Layout/Navigation E-Commerce Other:
Are there any Web Sites you can provide as examples of style, layout, or content features you would like to implement on your own site?
1.   What to note: 2.   What to note: 3.   What to note:
Are there any specific colors, themes, or fonts you wish for us to use?
No Yes
Do you wish to add new or additional photos to your Web Site?
No Yes If yes, approximately how many?
Will you require new e-mail accounts for you and/or others?
No Yes If yes, approximately how many?
Do you have a logo?
No Yes If no, would you like us to create one as part of your site design? Yes
Do you already have a web-hosting account you will use to host your finished site?
No Yes If no, would you like information about our hosting options? Yes
Will you require translation of your site into any other languages?
No Yes If yes, what languages?
Any additional suggestions or instructions?
Referred by:
How would you like to receive your quote (check all that apply):
E-mail Fax U.S. Mail Other: