Fields marked * must be completed Contact Name* Business Name Postal/ZIP Code Contact Telephone Number* Current URL (if available) Email Address* Address City                                 Province/State Country Industry or Business We'll need some more specific information so please check all the services that you require below. Web Site Design ~ Web Site Hosting ~ Web Site Redesign ~ Maintenance ~ Promotion Ecommerce ~ Graphic Design ~ Domain Name Registration click to search Please check and include from the examples below the types of information you require in your our web site: Home/Introduction Page Service Information Page/Pages About you/your Company Product Information Page/Pages "Printable" Order Form Page "Online" Order Form Page Shopping Cart w/ secure server ability Pages "Online" Survey Form Guestbook "What's New" Page of Your Website Updates and Announcements "FAQ's" Page for Your Viewers "Online" Newsletter Page Tips, Hints or Useful Information Page/Pages Contest Page/Pages Links to Related Businesses Page Awards You've Won Page Contact Details Page Comments Form Page for viewers to send their comments to you. Autoresponder to answer e-mail automatically. Other (please describe below:) If other selected, please describe here... Will you be providing the actual "content" for your website, or will you need us to write it for you?  Yes, I will provide all the content        No, I need you to write it. The purpose of this site is: Business ~ Personal ~ Non-profit What products or services does your company provide? Please select which "budget" you had in mind for your project: click to choose Less than $500 $500-$700 $750-$1000 $1000-$1500 $1500-$2000 $2000-$2500 $2500-$5000 $5000-$10,000 More than $10,000 Indicate below some specific examples of web design you've seen and liked URL you visited and liked (1) URL you visited and liked (2) URL you visited and liked (3) What Audience do you hope to Target? Other comments or questions: Fields marked * must be completed What is your desired implementation timeframe?* ASAP 2 - 4 weeks 4 - 6 weeks 2 - 6 months What information would you like to see from us? Notification of interest to discuss further General pricing info. A cost estimate specific to the site How would you like us to contact you? By email Fax Phone Surface mail

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