Your
Name *
Company
Name
Current
Date
E-mail Address: *
Phone
Number *
Business
Address
Website
Information
How quickly
are you looking to get started?
as soon as possible
within the next couple of weeks
within the next couple of months
in the next 1-3 months
later than 3 months
What is
the primary goal of your website?
to bring in new customers or business leads
to sell goods and services online
corporate website for staff, customers, shareholders
news or entertainment website (blog based)
database driven where customers can search for specific
information through your website
brochure site where clients can simply get more details
about your products an/or services
Approximately
how many pages do you think your website will need including
the home page?
1-6 pages
6-12 pages
12-20 pages
20-30 pages
30-50 pages
50+
What
special features will your website require if any
beyond
your standard brochure style website (text, images,
links ect.)
What
special features will your website require if any
beyond your
standard brochure website (text, images, links ect.)
Website
#1 - www.
Website
#2 - www.
Website
#3 - www.
Additional
Services
Will you
require web hosting for your website?
Yes
No I will purchase web hosting elsewhere
Will you
require the purchase of a domain name(s) for your website?
Yes
No I will purchase a domain name elsewhere
Do you
have an additional budget for SEO (search engine optimization)
and online marketing services?
yes
yes but at a later time
not at the moment
open to the possibility
What
is your current budget for your website?
note
- payment plans and/or financing is available through
our company
$500-$1000
$1000-$1500
$1500-$2000
$2000-$3000
$3000-$5000
$5000-$10,0000
$10,000-$20,000
$20,000-$50,000
Closing
Information
How would
you like us to contact you in regards to a price quote?
through email
through telephone
I would like to book an appointment
Please
quickly let us know how you heard of us?
a friend or referral
search engine (Google, Yahoo, Alta Vista)
sales representative
poster, flyer, advert
email advertisement
mailing list
social media outlet (facebook, youtube, twitter ect.)