WEB MEDIA WORLD

Please fill this form out with as much information as possible, the more information you can supply the more accurately we can serve you. All areas marked with a "*" are mandatory and must be filled for sending out the form , areas marked (optional) do not have to be filled out in order for the form to be sent.

CONTACT INFORMATION (1 of 7)


* Your Name:
* Email address:
* Phone:
Company:
Address:
City:
State:
Zip Code:
Country:
Fill Section Out Below If You Need Web Site Design or Development. Otherwise Please Move On To The End

BUSINESS / ORGANIZATION INFORMATION (2 of 7)

What does your business or organization do?
What is the web address of your top competitors?
What would you like to spend on your website design (U.S. funds)?:	We create a website for your budget. The larger your budget, the more hours available for us to create the layout and site design. It's that simple. EXACT PRICE YOU'D LIKE TO PAY: U.S. dollars $500 to $1000 (Personal, Informational, Small Business) $1000 to $3000 (Small & Med Biz, Flash / Non-database E-commerce) $3000 to $5000 (All Flash or Database-Driven Website) $5000 to $10,000 (Custom Large Portals for Auto or Real Estate) $10,000 to $20,000 (Complex Database / E-commerce)

SERVICES NEEDED (3 of 7)

Design Services:	Choose one of three: Brand NEW Website Redesign CURRENT Website (update look of existing site) Graphics-ONLY (you just need graphics, nothing else designed)
Customization:	Choose one of two: Custom (more expensive) Semi-Custom (using a pre-made template, less expensive)
Other Features Needed:	Check all that apply: Domain Email Account(s) (such as you@ yourwebsite.com JavaScript Rollover Menu Text Rollovers Guestbook Online Form(s) (Contact, Feedback, Survey, Questionnaire) # of Forms: (fill in ONLY if you checked Online Forms box)
Other site features?:
OTHER SERVICES NEEDED:	Logo Design (for website, business cards, stationery, etc.)
DOMAIN NAMES:	Website Address This domain is currently registered /it's my existing website I don't have a domain yet, I need to register one / this one
HOSTING:	Do you need web HOSTING? (billed annually)
	Yes No
MAINTENANCE:	Site MAINTENANCE (updates) after site is completed:

PROJECT DETAILS (4 of 7)

Approximately how many PAGES do you need designed or redesigned?:
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When do you want to start your project?	As soon as the ink dries on the contract! (ASAP) Within the week In 2 weeks In 1 month In 2 months More than 2 months
Do you have a deadline when the site must be completed?	Yes No If yes, when: (date or number of weeks, months, years)

Do you want to sell goods/services & accept payment online, such as an online store?
If "YES", COMPLETE E-COMMERCE SECTION If "NO" CONTINUE to next section

E-COMMERCE (5 of 7)

Do you currently accept credit cards ONLINE?	Yes No
Do you currently have a PayPal Business Accout?	Yes No
NUMBER OF PRODUCTS TO SELL ONLINE (or number of "" buttons needed)?	#
What you will SELL ONLINE: (Product type, Subscription type, etc.)

SITE CONTENT (6 of 7)

What elements will you provide to help create your website?	(company brochures, logos, pictures, text, catalogs)
How will you supply TEXT content?:	Electronic Format (text on CD, on disk, or via email) Hardcopy, handwritten (you'd require us to type all the text) Other:
How will you supply GRAPHICS content? (logo, pictures):	Digital Format (graphics on CD, on disk, or via email) You Need Us to Scan (digitize) your images or photos Number of Images To Be scanned (if needed) #:
Particular THEME you Do or Don't prefer?:	(Ex: professional, corporate, bold, fun, artsy, exciting, simple...)
Specific COLORS you Do or Don't prefer?:	(Ex: cool colors, pastels, a certain color family...)
Websites you like & Why you like them?	(Ex: a website address, template number(s), description of look)

Almost Finished! (7 of 7)

Subject:	(change subject if different)
Description of services needed / Message Comments:
How did you find out about this Website/Our Company?	This info is appreciated, but not necessary.
Give specific website or source:
Keywords you used at search engine to find Our website:
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