Please provide the following contact information:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
E-mail

What is the nature of your business?

Please select all the web page elements that you will want to include on your web site.

Home/Welcome Page                     
Products                              
Contact Us                            
Links to other Sites/Resources, etc.
Client Lists and Testimonials         
Bios/Profiles                         
Policies and Procedures               
Services                            
Photos/Logos                          
Mission Statement                     
Site Map                              
Database                            
PR/News Releases                      
On-Line Catalog and Secure Ordering   
Bulletin Board                        
FAQ                                 
Job/Career Opportunities              
Calendar of Events                    
Workshops/Classes/Seminars            
Awards and Recognition              
Other                                 

If OTHER, please indicate

Do you have a logo that you would like to incorporate into your site?

Yes
No

If you do not have a logo, would you like one created for you?

Yes
No

Do you have photos that you would like included?

Yes
No

Are these photos in a digital format?

Yes
No

How many photos are you expecting to include?

1-3
4-6
7-10
10+

What colors do you prefer?

Warm (red, pink, orange, yellow, brown)
Cool (blue, green, purple, black)
Neutral (gray, taupe, white, beige)
Pastels
Vibrants
Earth Tones

What do you want this web site to do for your business? Check as many boxes as you like.

Attract clients                             
Service current clients                     
Provide product/service information         
Become well-known in a particular industry
Promote a business/charity/public service/association                         
Sell products via an on-line store          
Provide useful free information           
Be a resource for others                    

Describe the image you are wanting to project.

Conservative/corporate
Fun/playful
Masculine
Feminine
Bright and Colorful
Soft and Restful

Do you want animation effects on your web site?

Buttons that look like they've been clicked
Scrolling Marquee
Animated Clipart
 

Do you require e-commerce functions?

Yes
No

If you have a domain name (i.e., www.domainname.com) registered for your site, list it below. If not, list your top three choices for a domain name to be checked for availability.

If you currently have a web host, please give the details.

Please provide the web addresses of some sites that you like and tell why you like them.

Please give a target date for the completion of your site.

Do you have the content/text of the web site written and readily available? Please select a response that accurately describes the readiness of your site's content.

Yes, written
Yes, on disk
No, nothing done yet but will provide it
No, would like Bookworm to provide copy

Will your site need periodic updating? Features such as product specials, calendars/schedules, daily quotes, etc. require that arrangements be made to perform regular site maintenance. Please choose your preference for site maintenance.

I will require daily/weekly/monthly updates to my site and will have the service included in my quote.
I will require daily/weekly/monthly updates and will handle the updates myself.
I will require only periodic updates and will ask for assistance as needed.

Please select a price range you would like to stay within.

$250-500
$500-750
$750-1000
$1000+

Please provide any other information you feel would be helpful to ensure you get the site you require.