Name:

Title:

Company:

Phone Number:

E-mail Address:

What primary service(s) do you want?
(check all that apply)

How may web site pages do you anticipate needing?  
(Ex.: Home, About, Services, Contact would be 4 pages)  

URL of your current web site:
(if applicable)

Need a domain name registered?

Do you have a web site host?

Purpose of your web site?
(check all that apply)

Size of your company?

Need a logo or artwork created?

Require photo/image scanning services?

Do you accept credit cards?

Which of the following services would you want?
(check all that apply)

Do you plan to sell online, or accept payments online?

Will you want audio and/or video features within the site?

Will you need stock art or photos provided by us?

Do you intend to use banner advertising on your site?

Will you need web site content written for you?

What promotion services would you like?
(check all that apply)

Time in which you need the site finished:
(this is important)

Select: Within 2 Weeks Within 3 Weeks Within 4 Weeks Within 5 Weeks Within 6 Weeks Within 7 Weeks Within 8 Weeks Within 9 Weeks Within 10 Weeks Within 11 Weeks Within 12 Weeks

Browser you want the site optimized for:
(Internet Explorer is the most widely used)

Select: Microsoft Internet Explorer (IE) Netscape Navigator (NN) Firefox (FF) Safari (S) IE and NN IE, NN and FF IE, NN, FF and S

Knowing what your web design budget is will help us respond with an quote tailored to your needs:

Select: Less than $500 $500 - $750 $750 - $1,000 $1,000 - $1,500 $1,500 - $2,000 $2,000 - $2,500 $2,500 - $3,000 $3,000 - $4,000 $4,000 - $5,000 $5,000 - $7,500 $7,500 - $10,000 $10,000 - $15,000 $15,000 - $20,000 Over $20,000 Uncertain

If possible, please provide 2 web addresses of existing sites that you believe are good models of the kind of web design and presentation that you are looking for:

Please include any other information below that you believe we should know about your project: