Please fill out this form and receive a quote back on the development of your website.
This is very preliminary but will give us a better idea
of what you have in mind.
(All information will be kept strictly confidential)

*Name:
*Company:
*Phone:
Fax:
*Email:
Website or Domain:
Registered?	Yes No

Your Mailing Address:

*Address:
Address2:
*City:
*State:	Alabama Alaska Arizona Arkansas California Colorado Conneticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nebraska Nevada Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tenessee Texas Utah Virginia Vermont Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick New Foundland Nova Scotia Ontario Prince Edward Island Provence Of Quebec Saskatchewan
*Zip:
*Country:

About your design:

Is this the first time you ever been involved in planning a Web site or a site redesign? Choose Yes No
Will this be a redesign of the current site or new design? Choose New Redesign
If it's a redesign, what did you like? dislike about the original site?
What is your estimated launch date? Pick One Now 1-2 Weeks 2-4 Weeks 1 Month 2-3 Months 4-5 Months 6 Months - 1 Year 1+ Year
Will the content be changing constantly on your site? Pick One Yes No Not Sure
If the information on your site will change constantly, are you intersted in being able to update it yourself? Pick One Yes No
Where will your site be hosted? Pick One HomePageOnline Other Host Our Own Server
If not with us, what features does your host provide? Database: Space:
If the information will change, what would change? How often?
Language of your site? Pick One English & Spanish English Only Spanish Only
If applicable, do you need it translated? Pick One Yes No
How many pages do you think your site will have? Pick One 1 2 3 4 5 6 to 10 11 to 15 16 to 20 20 + Not sure
In order for us to be able to give you a quote we need to know how much information will be included on your website.
Do you have this information available? Pick One Yes No
What form is it in? Pick One Current Website Electronic Form (Word) Printed Form (Brochure) Not Available
How can we get a copy?
Select the services you would like: Logo Design Help with Content Creation Audio/video Chat area(s) E-commerce Merchant Account Content Management by You Flash development e-Marketing
Additional:
How do you intend to advertise or drive traffic to your site?
Describe the purpose of this site:
How did you hear about us? Pick One Search Engine Friend or Bus. Associate Newspaper Ad Magazine Ad Convention Brochure Who? or Where?
How would you define the main goal of this Web site? Pick One Publicity or marketing site Nonprofit or community site Sales/e-commerce site Content-based publishing site Intranet Other

Comments, Additional, (tell us about your business):