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Website Needs Assessment Survey
Contact Information
Full Name*
Prefix First Name Last Name
Your Title*
E-mail*
Work Phone*
- Area Code Phone Number
Cell Phone
- Area Code Phone Number
Best Day/Time To Call
How soon would you like to start this project?*
Business/Organization Name*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Industry
How Did You Hear About Our Company?*
Needed Services
What Services Do You Need? (Check all that apply)*

Website Design & Development (We build your very own website) eCommerce Website Design & Development (Sell Products/Services Online) Merchant Account (To accept payments online - i.e: Visa, Amex, MC, etc.) Website Hosting (Makes your website available for visitors to view online) Search Engine Optimization (Makes your website outperform your competitors website) Search Engine Marketing (Promotion of your website so customers can find you) Facebook Page Design & Development (Social media visibility) Twitter Page Design & Developement (Social media microblogging) Logo Design & Development (Create a unique identity for your business/organization) Business Identity (Business Cards, Letterhead, & Envelopes) Promotional Printed Material (Brochures, Vehicle Door Magnets, etc.) Ning Network Design & Development (Your own private social network - Like Facebook) Business Consultation Marketing: Email, Post Card (Direct Mail), Social Media, Texting, Survey, Event Other
Project Budget
What is your approx. budget range for this project?*
What else would you like us to consider for your project?
Websites
If Re-design, what is your current website address?
Approx. how many pages will your website include? (i.e. Home, About Us, Services, Contact Us)
If you need an eCommerce website, approx. how many products/services will you be selling?
Describe your products/services
What are your goals for the website? (Check all that apply)

I want customers to contact me after reading about my products/services online. I want to save time by answering frequently asked questions on the website. I want to provide a place for people to view a portfolio of my work. I want people to buy my products/services online. I'm not sure why I need a website, I just think I do (Please help me decide).
Tell us what else you would like your website to do.
Technology Preferences (If known)
Technology required for your site (Select all that apply).

Basic HTML for a clean/professional look A little FLASH where appropiate 100% FLASH website eCommerce shopping cart Simple database with limited access I have no idea about the technology, but I know what I need the site to do)
What additional features do you want added to your site? (Select all that apply)

Contact Form Blog Password protection for certain areas Registration/Membership area Site search Videos Link to Facebook page Link to Twitter page Link to external site(s)
Other (List additional features not isted above, but desired)
Style Information & Preferences
What word/phrase best describes the style you envision? (You may check more than one)

Clean & Simple Crisp & White Elegant Feminine Masculine Bright & Bold Conservative Contemporary Pastel Color Palette Whimsical & Fun Formal/Professional Soft Tech Savvi
List 1st website you feel has a good design
List 2nd website you feel has a good design
What color palette do you have in mind?
Website Materials
Do you have a digital logo?
If you have a logo, upload it here
Do you have flyers/brochures, etc?
If you do, upload them here.
Do you have digital images/photos/videos that you own and would like to use on the website?
Upload them here.
Do You have FB Account?

Yes No
Please login with facebook first.
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Email Marketing | Social Marketing | SEO & PPC | Postcard Marketing | Text Marketing | Survey Marketing | Event Marketing | Websites | Facebook | Twitter | Ning | Graphics | Print | Logo's | Reputation Management

Website Needs Assessment Survey

Contact Information

Needed Services

Project Budget

Technology Preferences (If known)

Style Information & Preferences

Website Materials