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Information on designing Website / Portal:

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First Name*
Last Name*
Email Address*
Company Name*
City*
State/Province*
Country*
Phone Number*
Fax Number

Information on the website:

Is this a new site or a re-design/development?

New

Re-design/Development

Do you have a specific date you would like your project to be completed? If so, when? Please factor in the time for user requirement prototype review to final launch e.g.10 - 14 days

Check all that apply

Forms (Contact Forms, etc.)

Password/Members Only Area

Database Driven

Static pages

E-commerce / Shopping Cart Solutions

Other Custom Scripting/Programming

Flash Intro

Flash Animation

Total Flash Website

Virtual Tours

E-Business Application Developmen

Chat Room

Web Site Administration Section

Bulletin Board / Forum

Other, please specify

Estimated number of pages in your website:

Explain your ideas in as much detail as possible

Describe your business in as much detail as possible

Please provide us with a list of competitor web sites or sites you feel are comparable to your goals

Maintenance Section:

How often do you foresee the need to update your website?

None    Daily    Weekly    Twic in-week  Monthly    Yearly

Other, please specify:

What type of changes would you foresee? Please check all applicable

Text Changes    Graphical Changes    Price Changes

Individual Page Changes    Full Renovation

Other changes, please specify:

How much would you be willing to pay for the web design service?

below $1,000        $1,000 - $2,000        $2,000 - $3,000        $3,000 and above

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