Website Design & Development Form

Website Design & Development Form

Fill this out to the best of your ability. This form will replace multiple calls/meetings if filled out completely.
- Full Name
  
  First NameLast Name
- Do you have a street address?
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Phone Number
  
  Area CodePhone Number
- Company Number
  
  Area CodePhone Number
- E-mail
- Business Name:
- Please write your mission statement or company slogan, if you have one:
- Does your company have a logo? If so, please attach below:
  
  Upload a File
  
  Cancelof
- How long have you been in business?
- How many employees does your business have?
- Do you or your company have any licenses, memberships or affiliations that you'd like to highlight on your website?
- Have you already registered a domain name? If so, what is it and what company did you use to register?
- Who is your target audience/customer? (Age, gender, interests)
- When is your goal launch date for your website?
  
  MonthDayYear
- What services are you interested in?
  
  Other
- What would you like your domain name to be? If you already have a domain, please state it here.
- If you currently have a website, why are you designing/upgrading? What would you like to see/change/improve?
- Do you plan to maintain and update your site yourself?
  
  Other
- Will you require training?
- What is the purpose of your website? Check all that apply:
- What are your color preferences? Please mention 3 colors of your choice:
- Do you have any reference or competitors website that you would like to submit for review for the design process? Please list the website URL's & specific aspects of the site's that you like:
- When people visit your website, what would you want them to do? Please check all that apply.
- Do you have any preferences as far as images for your homepage?
- Upload image(s) below:
  
  Upload a File
  
  Cancelof
- Please submit any other information pertaining to your site below.
- Please select any of the following additional features you would like:
- How will you be accepting payment through your website? Please check all that apply.
- Please select real-time credit card processing options:
  
  Other
- Will there be a shipping option on your site? If yes, please select from the following:
  
  Other
- Is your website connected to a database? If yes, please select from the following:
  
  Other
- Are there any additional features you wish to add which have not been mentioned above? Please mention here:
- Who is your Account Manager?
- Should be Empty: