Contact Information

Contact Name:
Company Name:
Position title:
Phone:
Fax:
Address:
City:
State:
Zipcode:
*Email address:
Current WWW URL :

Desired Website Site Map

Please provide reference to a site map detailing all of the pages of your site. i.e. Home, About Us (Company Profile, History, Management Team), Services (Service 1, Service 2), Contact Us

Situational analysis of existing Website

Do you currently have a website?	Yes No
If no, please skip to next section.
Domain name registered?	Yes No
Domain name(s) :
Domain Host of current domain name:
Web Host of Current site:

Websites I like

Please list websites you like and list reasons you like that site such as: layout, menu setup, functionality, color, special features etc.

Navigation Preference

Please check your preference:

Horizontal (Across top) with drop-down flyout sub-menu
Vertical (on left or right)
Both
No preference

Module Requirements

Please check modules you are interested in having on your site:

Shopping/E-commerce
Calendar
Blog
Photo Gallery
Message Board/Forum
Vote/Poll
Listings (property for sale, autos for sale)
E-Newsletter
Member Login
Other (Please list:)

Forms

Will your website require forms? Examples: Contact Form, Newsletter Forms, Employment Request Form, etc.	Yes No
If no, please skip to next section.
Would you like the information from the form:
Emailed to an admin email address?	Yes No
Stored in a database?	Yes No
Email a copy to the user?	Yes No
Does this form need to be secure? (This is rare and only if form gathers sensitive info like: social security #)	Yes No

Data Migration / Content

The Content for my new website is in the following format(s):

It's on my current website
I have a database
Word Docs
Excel Sheets
Other (Please list:)

Customization Requirements

Describe any custom requirements. This may be an industry-related feature that is not listed in our module list. Example: retirement calculator. Please list the features/functionality here:

Identify Users and Permissions

If you need a login area (member module), please list the users of your site (admin, employee, customer, etc.)

E-commerce Requirements

If you will be needing a shopping/e-commerce module, please specify:

I will be using a Merchant Account and Payment Gateway	Yes No
I will be running payments in-house	Yes No
I need a Product Search Feature	Yes No
Other?

Search Engine Optimization

I would like my site optimized for search engines	Yes No
I would like to purchase a Search Engine Submittal Package	Yes No
I would like to add a counter to track my hits and referrals	Yes No
I would like an online marketing package	Yes No

Notes

Please summarize in paragraph format a summary of this website, including any information not covered in the questions above. (For example: We are selling widgets, and want a member area for customers…)

NOTE: Your free quote containing an estimate for the price of your website will be sent via email, so please put a valid email address!