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Name: Phone#: Best time to call: Email address: Contact Subject: New Website Update Existing Web Application

Business Information
I need to obtain some information about your business. Please fill out this form clearly and completely. We will review your answers during our phone conversation to make sure I understand your business. Don't worry, I promise not to share this information with anyone else. I will only use the information to better reflect your business on the internet through your website.

General Information

Company Name:    Nature of your business    Contact Name    Addess    City    State    Zip Code    Country    E-mail    Phone    Best time to call    Briefly describe in a few sentences the services and/or products your organization provides, then write a sentence describing your proposed target market:    What are your primary products and services that you'd like to offer on your website?    What are your desired results from having a website? Will your online business generate sales, offer services, support, generate leads, provide customer service, etc...?    Check off what you would like your website to accomplish (check all that apply):   Generate leads for your business   Develop mailing lists for promotions and/or announcements   Reduce printing costs   Customer Service and Sales Materials   Public Relations   Selling products and/or services   Target specific audiences   Market Research Other   Do you have a business plan for your website? Yes No Please estimate your budget for the website    budget undecided $500 -$1500 $1500 - $3000 $3000 - $5000 $5000 + Any Additional comments or questions?    Are there any sites already on the internet that you'd like to use as a guideline for your site?   http:// What exactly do you like about the above site(s)?    Who are your major competitors on the internet?    Do you have a website now?    yes no If yes, what is the URL of your website?    Is your current website doing what you expect?    yes no If no, what is wrong with your existing site?