First Name *
Last Name *
Year Business Established:
Mailing Address *
Postal/Zip Code *
Select... United States Canada
E-Mail Address *
Do you currently have a website?
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
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:
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?
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:
Style - Select the most appropriate
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.
Expected number of pages needed:
Will your site have forms or newsletter subscriptions?
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?
Will your site need a 'Members Only' area?
Will your site require the use of databases?
Will your site employ Flash, video, and/or audio?
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: