Contact Information

Contact Name (First | Last)*:

Company or Organization Name:

Office Phone:

Other Phone:

Fax:

E-mail Address*:

May we contact you by phone if we have questions regarding your request?:
Yes   No

When is the best time to contact you?:

How would you like to receive your quote?*:
By Fax
By Phone
By E-mail
By US Mail

About your business/organization

Type of Business:
Select Type Academic Large Business Non-profit Small Business

Please describe your business including products sold, industry, etc.:

What is your budget for this project?

Requirements of Proposed Site

Do you have a Domain Name registered? (e.g. www.mysite.com)
Yes   No

If you answered "Yes", please enter your Domain Name below:

If you do not have a Domain Name registered would you like us to register one for you?: (You will be billed a $15.00 yearly fee for a .com, .org, or .net address. Other address extensions may be available at higher costs.)
Yes   No

Do you require Web hosting services to house your web site? (You would be billed a monthly fee for this service based on the Web server type)
Yes   No

Do you require Webmaster maintenance services for your site after it is created? (You would be billed a monthly hourly fee for this service)
Yes   No

Would you like e-mail accounts for your Web site?
Yes   No

If you would like e-mail accounts, how many accounts do you need?

Would you like to set up an e-mailing list? (You will be billed a $20.00 monthly fee in addition to Web hosting.)
Yes   No

Approximately, how many pages will your Web site consist of?:

Approximately, how many graphic images/photographs will you have on your Web site?:

Would you like a form(s) on your site? (e.g. contact form or something similar to this page):
Yes   No

If you answered yes, how many forms would you like:

Approximately, how many "fields" per form?:

Would you like to accept credit cards on your site?:
Yes   No

Do you currently have a way to accept credit cards?:
Yes   No

Do you currently have a Merchant Account from a bank?:
Yes   No

How would you be supplying the textual content for your site?:
Electronic Format
Hardcopies (i.e. you would require us to type all the text
Other:

How would you be supplying the graphic content (i.e. your logo, pictures, etc.) for your site?:
Digital Format
You would require us to scan your images or photographs

After your Web site has been completed, would you like us to submit your Web site information to over 100 Internet Search Engines?:
Yes   No

Additional information, requests, ideas, or examples of Web sites you like:

Please tell us how you found our Web site: