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Some of Our Clients
Interstate Sports Academy
Moon Chaser Cruises
Vics Natural
Captree Princess
LeTip
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Complete as much of the form below as possible and one of our consultants will contact you with an estimate for Custom Web Site Creation, Marketing Packages, Hosting and E-Commerce Secure Shopping Cart System Solutions.Items Marked with an (
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Company Information
Company
Address 1
Address 2
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
(required only for US)
Zip Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkino Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherland Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
St. Kitts and Nevis
St. Helena
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Minor Outlying Islands
United States
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, U.S.
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia (Serbia and Montenegro)
Zambia
Zimbabwe
Telephone/E-mail Information
Current E-mail
Phone
Alternate Phone
Fax
Contact Information
First Name
Last Name
Best time to call
Telephone Number
(if different from above)
Type of service(s) your are interested in receiving information about:
Web Site Design
Marketing
Hosting
E-Commerce
Digital Photography
Credit Card Merchant Account
Printed Advertising
Authorize Net Gateway
Custom Scripts
Password Protection
Custom Forms
Multi-Media Presentations
Database(s)
Easy Access for Client to update
Consulting
Financing
General Information to help determine a final cost for your web site project.
What is the budget or budget range for this project?
$
Does this amount include a marketing budget?
Select One
Yes
No
Will this site require an E-Commerce Solution?
Select One
Yes
No
If Yes, Do you have a credit card merchant account?
Select Only If E-Commerce Site
Yes
No
If Yes, aprox. how many products do you have to sell?
Select Only If E-Commerce Site
1-10
11-30
31-60
61-100
101-250
251-1000
1001-up
If Yes, will you require any digital product photography?
Select Only If E-Commerce Site
Yes
No
How will you be marketing this site? (Mark all that apply)
Search Engines
Printed Ads
Brochures
Radio
Television
Internet Banners
Don't Know
You May make multiple selections
by holding down the CTRL key on your
keyboard while clicking on your selection.
Will you require creation of company Logos, etc.?
Select One
Yes
No
Maybe
Are you interested in a multi-media presentation?
Select One
Yes
No
Maybe
Favorite or Company Colors:
Type Of Look Desired:
Select Type Of Look Desired
Professional Corporate
Warm and Friendly
Catalog Look
Fun and Playful
Purpose and Goals
Describe the main purpose of this site. Also, list your company's expectations and goals from this site.
Describe any special requirements
you have for the site.
Hosting
Will we host and maintain this site?
Yes
No
My domain name is already registered
Yes
No
My domain name is currently hosted by
I need a domain name; I would like: (1st choice)
(2nd choice)
(3rd choice)
I would like my domain hosted by
Company domain is registered with
List your competitors websites. What do you like about them?
Also, Describe how your company is different than the competitor:
Competitor 1
Competitor 2
Competitor 3
Reasons
Overall favorite website, for whatever reason. Describe why you like it:
Favorite
Reasons
Additional Information
Reason for contacting us
Information Request
Proposal Request
Support Request
General Inquiry
Additional Comments
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