Order Form

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Our website development service always includes the latest modern designed themed websites with cinematic video creatives to showcase your business services and branding forever at its best.
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Are You a Current Webhost Media Customer?* This field is required.Have you signed up for a Webhost Media SynergyOne account?
YESNO
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I have the following services with Webhost Media* This field is required.You may select more than one service.
Website Hosting Plan
Domain Name Registration
Webhost Media Website
SynergyOne Printing Services
Webhost Media Logo
Webhost Media e-Books
Webhost Media Video Creatives
Webhost Media Graphic Design
Webhost Media Mail Wish Subscriber
Webhost Media Virtual Assistant Subscriber
SynergyOne meDigital SMS Subscriber
SynergyOne Real Estate Listing Packages
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Have you read the Webhost Media ''Respect your Brand'' e-Book?* This field is required.This is a helpful on-line guide describing the Website Development Process.
Yes, I read it on the Webhost Media website.
No, I have not received a copy as yet.
Received the email link, have not read it as yet.
Yes, I received it in a hard copy.
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Full Name* This field is required.Person taking charge of the website project and signing for the Website Scope Development Agreement.
First Name
Last Name
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Address* This field is required.Your Home Address is always required for the signing of the Website Scope Development Agreement
Street Address
Street Address Line 2
City
State
Post Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Mobile Number* This field is required.The person responsible to receive all communication for the website project
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Work NumberBusiness purposes
Area Code
Phone Number
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Confirm your current Website planning position* This field is required.Please select the best option that best describes your website requirement.
I don't have a Website. I need a brand new website.
I need to upgrade my current website.
I need to replace my current website completely as it is outdated.
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Please select the required Website Design Package Plan* This field is required.Please refer to the Webhost Media website page (https://webhostmedia.com.au/website-design/) for more information relating to the Design Packages covered below. The Data Limit is based on the Monthly Bandwidth allowance for the website hosting plan. The larger your website the more images and videos you use, the more bandwidth you will require. If you are not sure as to which plan best suits, don't worry your Project Manager will discuss your options in more detail.
The Business Set & Forget Design Premium Package (with Limited Monthly Data Bandwidth - may be subjected to Limited Business Video Creatives and Mobile Video Adds) data usage depends on the number of users viewing your website. If the monthly bandwidth limit is reached your website may be down and unreachable for the remainder of the month.
The Business Set & Forget Design Performance Package (with Unlimited Monthly Data Bandwidth - ideal when hosting your Business Video Creatives and Mobile Video Ads) - Highly Recommended. Dynamic performance.
The Business Set & Forget Design Enterprise Package (Unlimited Monthly Data Bandwidth - ideal when hosting your Business Video Creatives and Mobile Video Ads and requiring online payment gateways such as online shopping carts). Dynamic performance.
The one page Premium Design Website Package (with Limited Monthly Data Bandwidth - may be subjected to Limited Business Video Creatives and Mobile Video Adds) data usage depends on the number of users viewing your website. If the monthly bandwidth limit is reached your website may be down and unreachable for the remainder of the month.
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Do you have a registered Domain Name for this new proposed website?* This field is required.We also provide Website Domain Name Registration services. We are an Accredited Authorised Domain Name Registrar.
YESNO
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If yes, please provide Domain Name.* This field is required.We also provide a Domain Name transfer service. Your Domain Name will need to be transferred to Webhost Media.
Please provide full Domain Name registration including .com, .com.au, .net etc...
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Do you need Webhost Media to Design your Business Logo?* This field is required.Our creative and talented designers have unlimited ideas... a Business Logo is always required for a Website in varied pixel quality and sizes.
YESNO
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Please note that Webhost Media under our exclusive SynergyOne Design Studio provides the Logo Design Service which is included in the Website Design Package Plan cost. Please note that any additional Design Studio artwork orders requested after the Website is completed and deployed on the server will be billed separately as a new order.
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Do you have any Social Media accounts?* This field is required.Such as Facebook, YouTube, Instagram etc...
YESNO
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If, yes, please provide Social Media accounts details* This field is required.We can integrate your accounts into your new website
Please provide link pages of your Social Media accounts for preview
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Do you have Website Content and Images?* This field is required.If not, we can provide the copyright content and professional high resolution quality images. High quality well researched Images are critical for a professional Website look.
YESNO
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If yes, please describe the type of content and images you can provide* This field is required.Please also include your Logo image details here.
Please provide as much detail as possible eg: do you have professionally written content or professionally designed images …. etc...
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Do you currently have a business video(s) that you would like to integrate into your new website?* This field is required.We also provide a Video Creative Service. Including Mobile Videos Ads that you can share using Viber, WhatsApp, Facebook and YouTube or Instagram and SMS and MMS. You can also have the videos playing on your website. A video is worth over 1,500,000 words.
YESNO
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If yes, please describe the type of video(s) content and background you can provide* This field is required.Please advise the number of videos you have and how long (in minutes) they run for. Please also confirm the video file extension. Please also provide details as to who produced the video(s). We will make sure that the video(s) are compatible to be uploaded on your new website.
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We understand that website written content is not always easy to provide. At Webhost Media website services we can produce the required copyright content for different industries as part of the pricing plans. This is not a typical service provided within the industry. Content is also very critical for creating emotive professional expressions.
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Please select required tabs for the website navigation main menu* This field is required.The website menu tabs help users navigating around your website. We will of course provide guidance.
Home Page
About Us
Meet The Team
Case Studies
Order and Quotation Forms
Contact Us Forms
Google Maps for Contact Us
Our Services
Image Gallery
Privacy Policy
Terms & Conditions of use
Webmail Integrated with Website
Registration Forms
Web Data Capture Forms
Testimonials from Customers
Disclaimer Policy
Portfolio of Our Work
Other
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You may also choose additional services and features for your website, if required.Some of these features are provided at no extra cost in the Set & Forget Plan. Please discuss in more detail with your project manager.
Shopping Services Cart
Banner Design
Model Brand Identity
Promotional Landing Page
Advertisement Management
Logo Design
Website Copyright Written Content
Promotional Brand Theme Videos
Promotional Brand Video Image Slide Shows
Mobile Video Ads
Blogs
Booking & Reservations interface
Products Pricing Tables
Other
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Will you be using your new website as a shopping cart or e-commerce store front to sell products and services?* This field is required.If you sell goods and services online then you may need additional SSL security and warranty considerations.
YESNO
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Please note that any additional services and features may attract additional costs and not form part of the Website Design Package Plans offered. Please discuss further with your Webhost Media Project Manager.
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Your Business Industry* This field is required.Please select from the drop-down menu.
Please Select
Please Select
Accounting
Advertising
Video Producer
Education
Entertainment
Finance Broking
Financial Planning
Hairdressing Services
Legal
Management & Recruiting
Medical
Real Estate
Restaurant & Catering
Retail
Sports & Coaching
Printing Design and Digital
Other
Various industries require different Disclaimer Notices and Privacy Policies.
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Your Business Name* This field is required.As Per Registration Details.
As included in ASIC records.
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Your ABN Number * This field is required.In order to run a website you must have a current registered ABN.
As per ASIC records. This information is required to register your Website Domain Name and respective Hosting Plan.
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Your Business Background* This field is required.Please provide a story line of your business' history such as when it was established, type of service etc... and the reason why you need a new website.
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An Overview of your Business* This field is required.Please provide details on how your business generates income? How do customers currently buy from your business? What makes your business unique within the marketplace? Do you have a Brand Marketing Strategy?
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Your Business Target Audience and Market* This field is required.The demographic information and psycho-graphic traits of your customers is very important ... Knowing what websites customers visit and brands they buy into, can help inform you about the design styles that appeal to them, what type of content they like. For example; what is the main age group of your customers? What areas do they live in? What type of cars do they drive? Are they professionals or tradespeople or business owners? What does their family structure look like?
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Who are your main Business Competitors?* This field is required.Knowing your competitors is great business power. It’s funny, the level of influence that competitor’s can have on your business and marketing strategies. You need to decide, is your business trying to stand out, or fit in or stay ahead of the pack? There’s not a right or wrong answer here. The more information you provide the more insight we gain to reflect your end website strategy and design.
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Do you currently provide a regular Newsletter to your customers?* This field is required.Newsletter can be by monthly subscription such as MailChimp or Campaign Monitor etc...
Yes, we are currently mailing printed Newsletters
Yes, we are currently using an online Newsletter provider
We don't need a Newsletter
We are thinking about starting a Newsletter
We would like to discuss this further
Other
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Your Current Business Email Network Hosting facility* This field is required.Please let us know if you are currently using your Business Domain Name email for day to day business communication, if so, please provide the number of email accounts you use and the name of the email company/hosting provider. Also please confirm whether you are using eg; Google Business Suite, Office 365 etc... as this is critical information that we require in order to assess the viability of our services for your business requirements. Please also confirm the number of years you have been associated with this email network product.
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Do you have an Email Network IT Contractor that manages your current business email network?* This field is required.This is a very important question as we would need to discuss the technical details with your IT Contractor.
YESNO
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Please provide details of your Email IT Network Contractor* This field is required.Please provide contact details and name of company and individual that supports your email network. Please also confirm the number of years you have been associated with this email network IT contractor. This information is critical.
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Please upload your design ideas, images and Logo(s) here if available for our reviewYou can upload any files, including your logo, photos, brand guide, fonts, content copy, and any other documents that will give our designers more insight into your project.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
pdf, Worddoc, mp4, avi, jpg, png etc.
Cancelof
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Please provide links to any website(s) that inspire you on the WebPlease type in any page link(s) showing any designs or imagery you like that reflects the style that you are looking for.
This will provide our designers with additional information.
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What is your website deployment timeline?* This field is required.Your designer will confirm whether your delivery date can be met based on project scope and availability.
1 Week
2 Weeks
3 Weeks
1 Month
Not sure. Would like to discuss further.
Other
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Your e-mail address* This field is required.The email address relates to the person responsible for receiving the website project updates.
It can be either a personal or a business email address.
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Comments* This field is required.Please be as detailed as possible. Please provide any details that have not been fully covered in previous questions above.
Please provide any additional information relating to your website design, this will help our designers to better serve you.
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DISCLAIMER: Please note that it is mandatory that your Website Business Hosting Service (as we become the hosting administrators for IT and back-office website technical support to make sure that everything will always run smoothly) be provided by Webhost Media an authorised accredited registrar as we cannot work efficiently and in your best interest with other third parties hosting platforms and Domain Name services providers. This is a fundamental requirement and condition of our agreement in order to provide you with ongoing design, content management, and technical support services as required.
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Terms & Conditions* This field is required.Terms and Conditions of Use. Please read carefully.
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Signature* This field is required.Please sign using your keyboard mouse.
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Tick the box below* This field is required.Thank you. You have now completed the Website Design Brief. For security purposes, please tick the box below confirming that you are a human, not a robot. Then, please click on the submit button. Please note if you receive errors whilst trying to submit the form please review the status bar below that will highlight the page numbers of the form that have not been fully completed. Click on the respective pages and complete accordingly. You should then be able to submit.
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