Website Request Form

1

What is your name?* This field is required.

First Name

Last Name

2

Please provide your email address.* This field is required.

example@example.com

3

What service are you requesting?

Website Creation or Redesign

Digital Marketing and Advertising

Job Search/Resume

Business Insights and Auditing

No service but a potential partnership

4

For whom are you requesting or inquiring for this service?

Myself

My Business

5

What is the name of the business for which you are inquiring?* This field is required.

7

What is your title/role in the business?* This field is required.

8

Does your business need a new website or a redesign?* This field is required.

I need a new website.

I need a website redesign.

I'm not sure.

9

When do you need your site completed by?* This field is required.

Date

10

Which should take priority: Features or Aesthetics?* This field is required.Feature=A specific function. Aesthetics=Design, beauty and feel.

Features

Aesthetics

11

Who will be handling website maintenance* This field is required.

Within the company, outside of our department.

A 3rd party agency.

I would like for you to maintain it.

I personally will be handling maintenance.

Within the company, likely a team member.

12

Have you identified your brand AND created a branding guide/standard?* This field is required.

YESNO

13

How do you evaluate success?* This field is required.

14

What is the URL to your current website?

15

Do you need a new domain name?

16

Do you need hosting?

YESNO

17

Is your website used for e-commerce?

YESNO

18

For your e-commerce site, is there a rotation of products to be featured?

YESNO

19

In a few sentences, describe the nature of the partnership or opportunity for which you are inquiring.

20

What is the best number for us to reach you?* This field is required.

Please enter a valid phone number.

21

When is a good time to contact you?

22

Completion Time