Company Name:
*Contact Name:
City:
*State:	AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
*Email:
Phone:
Contact me by:	Email Phone
*Do you have a domain name?	No Yes
*Do you need web hosting?	Yes No
*Is this a new site or redesign?	New Site Redesign
If a redesign, please give  Current Domain Name (URL):
*Number of pages:
*Size of your company (select one):	Small business Medium business Large business
Purpose of your site (select all that apply):	Sell products/services online. Marketing tool to get new customers Information resource for current customers Provide customer service
What type of products or services?
What e-commerce services do you want? (select all that apply):	Shopping Cart for approx. (#) products/services Site that uses information from our database.         What type of database do you have?        Email newsletter Form for surfers to enter information for data gathering Site that surfer can search internally Surfers can download software or other files
*Do you accept credit cards? (select one):	Yes      No     We would like to accept cards
*Do you want to set up a merchant account for credit card transactions?	Yes No
*Does any part of your site require membership capabilities or private login pages?	Yes No If "Yes", please describe.
*Does this site require any forms such as contact, registration or quote forms?	Yes No If "Yes", please describe.
*Desired Graphics Level:	Low Average High
*Does this site require any Flash Animation?	None Flash Intro Flash Logo or Image 2-4 Flash Movies Total Flash Site
What other sites do you like that are similar to the type of design you want? What do you like about them? What do you NOT want on your site?
What promotion services would you like? (select all that apply):	Optimize pages so good indexing by engines Submit site to engines and directories Improve link popularity Recommend paid submission and Pay-per-click programs
What other promotion services would you like?
What are your goals for the site?
*Approximate time frame needed for completion:
*Budget range:	Please select the closest range $1000-$2000 $2000-$3000 $3000-$5000 $5,000-$8,000 $8000-$12,500 $12,500-$15,000 $15,000-$25,000 $25,000-$35,000 $35,000-$50,000 $50,000 and up I prefer not to answer